Junior Doctors: Industrial Action

Ben Gummer Excerpts

Thursday 24th March 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what steps he is taking to avoid further industrial action by junior doctors.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Yesterday, the junior doctors committee of the British Medical Association, in continuation of their dispute over how junior doctors should be paid for working on Saturdays, announced that they would be withdrawing emergency cover during two days, 26 and 27 April. If the BMA proceeds with this action, it will be unprecedented in the history of the national health service.

Let me be clear first about the impact on patients. We will do all in our power to ensure that patients are protected. However, given that patients presenting at hospitals in an emergency are often at a point of extreme danger, the action taken by the BMA will inevitably put patients in harm’s way. That the BMA wishes to do that to continue a dispute over how junior doctors are paid on Saturdays is not only regrettable but entirely disproportionate and highly irresponsible.

The hon. Lady asks what the Government have done to avoid industrial action. Let me be clear on this also. Consistent with our promise to the British people to reduce variations in care across the seven days of the week, the Government could not have done more in their efforts to avoid industrial action. Although both the BMA and NHS Employers believe the current contract to be seriously flawed, the BMA has walked away from negotiations not once, not twice, but three times—unilaterally thwarting the efforts, made in good faith, to come to a negotiated settlement on a better contract.

Time and again, the Government have implored the BMA to return to talks. Time and again, the Government have extended deadlines. Time and again, the Government have listened and responded to the BMA’s concerns, making agreed changes to the proposed contract. The Government have provided every possible means to ensure productive talks. We have charged the most experienced negotiators in the NHS to work with the BMA. At our invitation, we have discussed the contract at ACAS not once, but twice. We have asked one of the most respected chief executives in the service, Sir David Dalton, to attempt to reach a solution. Yet, despite all this, the BMA has set itself against talks, refusing to negotiate on the few remaining points of contention, even though it had previously promised to discuss them. We are in the very odd situation of being faced with a trade union that is escalating strike action, despite having been consistent only in its refusal to negotiate on behalf of its members.

The country cannot be held to ransom like this. At some point, a democratically elected Government must be able to proceed to fulfil the promises they have made to the people. Governments cannot be held hostage by a union that refuses to negotiate. That is why, having exhausted every single option open to us with the BMA—with the BMA refusing to talk—and having listened to the advice of Sir David Dalton and others to move on from the uncertainty that this dispute was creating, the Government have, to their regret, decided to move on and implement the contract.

We will very soon be presenting the new contract directly to doctors so that they can see for themselves that the new contract is safer than the one it replaces, is fairer than the one it replaces, is better for patients than the one it replaces and is better for doctors than the one it replaces. By seeing the detail of the contract for themselves, I am confident that doctors will see the strike for what it is: disproportionate, ill-judged, unnecessary and wrong.

[Heidi Alexander]

The Minister has spoken for a number of minutes, but he has not answered the question. I asked what further action the Government will take to avert industrial action and the escalation planned for the 26th and 27th, and there was absolutely no response.

This is a worrying time for patients and the NHS, and it is nothing short of a disgrace that, yet again, the Health Secretary has failed to turn up. If this walkout goes ahead, it will be the first time ever that junior doctors have fully withdrawn their labour. Nobody wants that to happen, so let me focus my questions on how we might find a way through this very heated and deeply distressing dispute.

Yesterday, the Health Secretary was reported to have said that “the matter is closed.” May I urge the Minister to think again? He should think about how it will look to patients if the Secretary of State spends the next four weeks sitting on his hands, instead of trying to avert this action. Was the Government’s former patient safety adviser, Don Berwick, not right to have called on Ministers to de-escalate the situation? How does describing the junior doctor element of the BMA as “radicalised”, as the Minister did on Monday, help to de-escalate things? May I gently suggest to him that his tone and choice of words are making a resolution harder, not easier, to achieve?

The Minister is an intelligent man, and I know he will be talking to the same senior NHS leaders I talk to. Deep down, he knows that this contract has nothing to do with seven-day services and everything to do with setting a precedent to save money on the NHS pay bill—change the definition of unsociable hours in this contract and pave the way for changing it for nurses, porters and a whole host of other NHS staff. Am I wrong, Minister?

Finally, may I simply ask the Government to start listening to patients? The Patients Association has said:

“The Government’s decision to impose contract terms on junior doctors is unacceptable…It is clear that the acrimonious dispute…is unnecessary and damaging.”

National Voices, which represents 160 health and care charities, said yesterday:

“We are calling on government to drop the imposition of a new contract”.

The Government have 32 days to prevent a full walkout of junior doctors. The Secretary of State may think that the matter is closed; I say that that is arrogant and dangerous in the extreme. This is an awful game of brinkmanship and the Government must press the pause button before it is too late.

--- Later in debate ---

[Ben Gummer]

I thank the hon. Lady for her detailed questions, put with her customary grace—and I mean that. She raised a number of issues, and I will deal with her first point last, if I may. She mentioned the Secretary of State’s comments to the Health Service Journal earlier this week. We have been negotiating a contract for three and a half years and have reached the point where the counter-party—the British Medical Association—refuses to discuss the remaining 10% that is not agreed, despite the best efforts of the most experienced of negotiators and one of the most respected chief executives in the NHS. In his judgment, there was no further purpose to negotiations, because the BMA refused to discuss those points. The Government are therefore faced with a choice: either they allow the BMA, with that refusal, effectively to veto a contract, or they implement the 90% of the contract that has been agreed and make a decision on Saturday pay rates, on which they have provided considerable movement from the recommendations of the independent doctors and dentists pay review body. I suggest to the hon. Lady that it is not the Government who are causing or calling industrial action, but the British Medical Association.

[Heidi Alexander]

Look at your actions over the past year!

[Ben Gummer]

The hon. Lady asks both in her urgent question and from her seat about our actions. All I can say is that I personally have implored the leaders of the BMA to come to talks on a number of occasions, but there is a point at which it is not possible to continue discussions, first because the counter-party refuses to talk, and secondly because the BMA has promised to talk on so many occasions, only to renege on that promise at a future point. We have to move ahead with a contract that is better for patients and better for doctors.

The hon. Lady asked about the reasons for the contract and claimed that it has nothing to do with seven-day services and something to do with the pay bill. Not only is this contract cost neutral, but transition payment is being funded from outside the pay envelope. This has nothing to do with the pay bill; it is about recognising a core concern of the British Medical Association, the Government and NHS Employers that the current contract is not fit for purpose and needs reform.

One of the many reasons for that is to make sure that care can be delivered more consistently across seven days of the week. It introduces for junior doctors terms for Saturday working that in several senses are more generous than those afforded to “Agenda for Change” employees. It could be a judgment for the House as to whether it is equitable for that to be the case, but that was the negotiated position, as far as we reached one, with Sir David Dalton. I ask the hon. Lady and junior doctors to think carefully about resisting a pay offer that is more generous in form and in number than the one that is given to porters and nurses working in the same teams.

The hon. Lady asked whether she was wrong to say that this was part of a wider narrative to reduce the pay bill for “Agenda for Change” unions. I say to her unequivocally that she is. This has nothing to do with the form or payment of “Agenda for Change” staff. It is to do with the terms of contract and employment for junior doctors. It is about making a contract that is safer and fairer for them and better for patients.

Finally, I return to the point that the hon. Lady made at the beginning of her question. It is not the Government who have caused the industrial action. We have bent over backwards to try to avert it, and I suggest that we have done more than some previous Labour Secretaries of State to avert industrial action. The one thing that will help to stop this industrial action is clear condemnation from the Labour party. There is one remaining question in the whole debate, and that is the position of Her Majesty’s Opposition.

The hon. Lady has been assiduous in holding the Government to account. She has been right to do so, and she has done so with the decency that has earned her respect on both sides of the House, but she has not yet told us what the Opposition’s position is. I can understand that, although I do not agree with it, when industrial action is to do with elective, non-emergency care. The call for strike action on emergency care is of an altogether different order, however, and it demands a response from the Opposition, because this is about emergency cover for patients. The Opposition need to say clearly whether they support or condemn the action. If the hon. Lady remains silent on the matter, I will only be able, as will the House, to draw the conclusion that she supports the action. If that is so, it is a very sad day for the Labour party.

[Mr Speaker]

Order. I gently say to the Minister, whose emollient and statesmanlike tone is widely admired across the House, that briefly to refer to the stance of the Opposition is legitimate, but dilation upon it is not. I know that he is drawing his remarks to a close.

[Mr Dennis Skinner (Bolsover) (Lab)]

That is exactly what I said.

[Ben Gummer]

I am glad to see, Mr Speaker, that you are in agreement with the hon. Member for Bolsover (Mr Skinner).

[Mr Speaker]

No, I think the hon. Member for Bolsover is in agreement with me.

[Ben Gummer]

We have mutual agreement, in that case. You were right to draw attention to this, Mr Speaker. All I will say is that the strike would be more easily averted if Her Majesty’s Opposition were to condemn it absolutely. If they do not, all that says is that Her Majesty’s Opposition are in thrall to the militants within the unions and are putting decent members of the Labour party in an impossible position.

[Several hon. Members rose—]

[Dr Julian Lewis (New Forest East) (Con)]

I am greatly obliged, Mr Speaker, as always. Will the Minister tell me whether, having quite rightly balloted its members on general strike action, the BMA has balloted the junior doctors on the withdrawal of emergency care?

[Ben Gummer]

My right hon. Friend raises an important point. I believe that the legality of the action is correct and that the BMA is within its rights to do as it is doing, but that does not change whether it is right or wrong. Many junior doctors who may have supported the BMA in the withdrawal of elective care will be profoundly worried about that escalation.

[Kirsty Blackman (Aberdeen North) (SNP)]

It is disappointing that, as both the Minister and the shadow Minister pointed out, negotiations are not currently ongoing. Junior doctors are rightly concerned. The Secretary of State has promised that more junior doctors will work at weekends, while, at the same time, no fewer will work during the week. The UK Government decided this week that the best way to reform disability welfare payments is to listen to disabled people. Will the UK Government now make a similar U-turn on NHS reform and concede that the best way to reform the junior doctors contract is to listen to junior doctors?

[Ben Gummer]

I thank the hon. Lady for her question, but I suggest that listening to junior doctors on their need to have a better work-life balance, to ensure that the contract is safer for patients and to address their legitimate complaints about the way the existing contract works is significantly different from listening to the junior doctors committee, whose actions seem to have ulterior motives. All I would say is that we have listened consistently to the concerns of junior doctors both through the negotiators they have appointed and in relation to those they have raised on the ground. That is why we have come to an agreement on 90% of the contract.

Many of the issues settled within the contract were not requested by the BMA. For instance, one of the complaints made by junior doctors for many years is the fact that they have to book leave so far in advance that they often have to miss important family events. We sought to change that, and we did so in the new contract of our own accord. It is one of myriad changes that will make this contract better for junior doctors. That is why the sooner they have it in front of them—we are working very hard to make sure that happens soon—the sooner they will see that this contract is better for them and that they have been misled.

[Andrea Jenkyns (Morley and Outwood) (Con)]

I thank the Minister for coming to the House today to set out the Government’s position on this dangerous and irresponsible strike. Quite frankly, I am appalled by the fact that the Labour party has not condemned these strikes. Throughout the negotiation, the Government’s door has been open, and the BMA was given more than enough notice before the Government were forced to impose the contract. In this negotiation, the BMA got 90% of what it wanted, so this strike is essentially about pay for working on Saturdays. What other essential public servants, from firefighters to the police, would get such terms for working on a Saturday? Will my hon. Friend please tell me what impact the strikes will have on patient safety?

[Ben Gummer]

We will do everything in our power to ensure that patients are protected. We have a very robust assurance programme, conducted by NHS Improvement and NHS Employers. We will do everything we can to ensure both that the number of elective operations cancelled is as low as possible, consistent with the needs of safety, and that emergency cover is provided. Withdrawing the number of doctors that the BMA will withdraw in this action means that there is an increased risk of patient harm, and I am afraid that the BMA and its members need to consider that very carefully in the weeks ahead.

[Kevin Barron (Rother Valley) (Lab)]

It is clear that the Government are in a very difficult position, hence the Minister’s attack on Opposition Front and Back Benchers. I have to say that, from my experience of nine years on the General Medical Council, I do not recognise the various descriptions of the doctors’ profession that the Government have given over the past few weeks, including as being radicalised. We all know that this dispute should and will be settled not by imposition but by negotiations around a table. It seems to me that instead of using, at the Dispatch Box and elsewhere, rhetoric that has fired this up, Ministers would do much better to react to what the BMA said yesterday, which is that it wants

“to end this dispute through talks”.

Why do the Government not get on with it, keep us out of it and just do what people expect them to do?

[Mr Speaker]

Before the Minister replies, may I remind the House that this is an urgent question, not a debate under Standing Order No. 24 or a series of speeches? There seems to be predilection among colleagues to preface whatever question they ultimately arrive at with an essay first. A number of Members say, “Oh, I have to say this.” No, Members do not have to say anything; they have to ask a question, preferably briefly. That is all we want to hear.

[Ben Gummer]

The right hon. Gentleman should know that we have negotiated with the BMA for more than three years. We have a choice either to cave in, which would produce a bad contract—much like the 2000 and 2003 contracts, which we are trying to correct, because everyone agrees they are wrong—or to move forward, accepting the fact that 90% of this contract has been agreed. We believe that it is in the interests of patients and doctors to do the latter.

[Helen Whately (Faversham and Mid Kent) (Con)]

Does my hon. Friend agree that this time the BMA has gone too far, and will he join me in calling on junior doctors to reach beyond the BMA and put their patients first and the BMA leadership second? Junior doctors are the future of the NHS, and they must play their role in constructively solving this problem.

[Ben Gummer]

I agree entirely with my hon. Friend, and we need this new contract to help junior doctors to achieve a better work-life balance, so that they can maintain their studies, training and experience in a better way than is currently allowed. We must also ensure that they are not exhausted by the contract, which is what happens under the current failed contract. It is in their interest for the new contract to be introduced, and I hope that in the coming weeks they will revise their view of whether this industrial action is truly necessary.

[Paul Flynn (Newport West) (Lab)]

Thanks to the Welsh Assembly, my constituents will not suffer the anxiety caused by the future strike. Does the Minister expect the public to support doctors who dedicate their lives to the health service, rather than the nasty party that opposed the set-up of the health service, and whose support for it has always been half-hearted and grudging?

[Ben Gummer]

It is unfortunate that the hon. Gentleman needs to use such language. The Conservative party is achieving better outcomes for patients in every single metric than the Labour party in Wales, which is consistently letting down patients in the Principality—an appalling aspect for people who are in need of care in Wales.

[Mike Freer (Finchley and Golders Green) (Con)]

Will the Minister confirm that the escalation by the BMA makes a settlement less, not more, likely?

[Ben Gummer]

It is hard to have any discussions on any matter with the BMA in good faith when there is an escalation to the withdrawal of emergency cover on a matter of pay only. That unprecedented situation makes our collective bargaining arrangements with the BMA very difficult.

[Mr Dennis Skinner (Bolsover) (Lab)]

The Minister is also on premium pay, and he would be on strike if other Ministers were getting more than him. Is he aware that nearly all patients who are in work and go to hospital to be treated by these doctors are also on premium pay at the weekend? Does he realise that the Government are not in a very strong position just about now? They have had to retreat on their Budget. Does he understand that in this world, where nearly everybody in a trade union gets premium payments on Saturday, the same should apply to those in hospital by the same amount? Then we should pay the nurses and all the rest of them an equivalent amount. That is the Minister’s problem—get weaving!

[Ben Gummer]

I have had this discussion with the hon. Gentleman before, and he is wrong. The Review Body on Doctors’ and Dentists’ Remuneration carefully considered this issue, and its proposals for Saturday pay for junior doctors were improved on by the Government unilaterally. We made a better offer than that in the review body’s independent report, which studied other comparable professions. This comes back to a question for the hon. Gentleman: will he really turn down better terms for junior doctors, in both term and number, than those for Agenda for Change unions? If so, that is a very sad thing for the Labour party.

[Peter Heaton-Jones (North Devon) (Con)]

Does the Minister agree that the most important people in this are the patients? They should be at the forefront of our mind, and it is for their sake that this wholly unnecessary escalation of action must come to an end.

[Ben Gummer]

I agree wholeheartedly with my hon. Friend, which is why it would be helpful to have an unequivocal condemnation of the strike from the Labour party, which would send a message from this House that the withdrawal of emergency care is wrong.

[Tom Brake (Carshalton and Wallington) (LD)]

A junior doctor at St Helier hospital states that

“this contract is unfair, unsafe, uncosted, unevidenced, ineffective, unassessed for impact and risk, and unnecessary.”

With doctors depressed and demoralised, and with the revelation in David Laws’s book that the NHS required £15 billion to £16 billion, does the Minister agree that the failure to resolve this dispute is putting a huge amount of unnecessary pressure on the NHS, and that the Government and the BMA must settle?

[Ben Gummer]

This is what the Liberal Democrats have come to: quoting the books of their own losing candidates—a very odd situation. I think it sad for the right hon. Gentleman to come to this House not having read Sir David Dalton’s letter, which refutes every single one of the points he quoted at the beginning of his question. The fact is that the contract will be fairer and safer—better for patients and better for doctors.

[Bob Blackman (Harrow East) (Con)]

Does my hon. Friend share the frustrations of a former Health Minister, namely Nye Bevan? The BMA battled against him when he was trying to set up the NHS, leading him to state in this place that it was not his fault he could not agree with the BMA as the Government had never appointed a Minister who could agree with the BMA.

[Ben Gummer]

Reading Bevan’s remarks from 1948, as from 1946, are a revelation. There is so much truth in them. The fact is that there are parts of the BMA that want to come to a good and constructive deal with the Government. The general practitioners have just done so. It is just very sad that this once-respected trade union is being dragged to this position by the junior doctors committee. It is doing great damage to the reputation of the BMA, and, in allying themselves to that part of the BMA, great damage to the reputation of the Labour party.

[Valerie Vaz (Walsall South) (Lab)]

If the Minister really wants to avert the strike, I suggest he writes to the BMA today with a list of the sticking points and dates on which to meet.

[Ben Gummer]

Sir David Dalton wrote to the BMA with precisely that list. The BMA refused to reply to him. He made the judgment that there was no point in continuing negotiations because it was refusing to discuss, in any event, the remaining matters. The Government have to move ahead. We have been on this for three and a half years and it is better that we move ahead.

[Jeremy Lefroy (Stafford) (Con)]

It was with great sadness that I learned of the BMA’s decision, which is not in the interests of patients and not in the interests of its members. I urge it to withdraw the threat of action. At the same time, will the Minister consider pausing the imposition of the contract, so there can be meaningful discussions? Those discussions have to take place in the context of a withdrawal of strike action.

[Ben Gummer]

I say gently to my hon. Friend that meaningful discussions require both good faith and a will to talk from both sides. That is consistently the case on the Government side, but it has not been consistently the case for the junior doctors committee of the BMA. The fact is that this contract is better for patients, the patients he seeks to represent. It is better for doctors, the same doctors he seeks to represent. Therefore, any further delay would be bad for patients and bad for doctors. That is why we must move ahead with the implementation of this contract.

[Dawn Butler (Brent Central) (Lab)]

The Minister’s tone, language and approach today show how and why he has failed in these negotiations. I am sure my hon. Friend the Member for Lewisham East (Heidi Alexander) could easily teach him how to negotiate and how to avert the strike. Will the Minister please explain how he proposes to have more junior doctors working at the weekends, without having fewer working during the week?

[Ben Gummer]

The point of the new contract has, in part, been to try to achieve fairer rostering through the week and weekend. It is in response to the doctors and dentists pay review body, which took evidence from managers and senior clinicians within the service. It is their judgment that we, as Ministers, have to respect. It is not for us to make up new terms; it is to listen to those who have experience. We have been talking for three and a half years. Part of those talks were led by Sir David Dalton, who is one of the most respected people in the NHS. If he could not achieve a conclusion, I doubt very much that I, or any other Minister, would be able to do so.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

How many junior doctors are members of the BMA? If the BMA is set on this activity, I encourage my hon. Friend to start talking to those who are not members. Perhaps he could talk to other health workers, too, including pharmacists, and get them involved in trying to deal with this.

[Ben Gummer]

My hon. Friend is right to point out that not all junior doctors are members of the BMA. In fact, a significant minority are not, which is why fewer than half have been turning out for industrial action. The number has been decreasing with each successive strike, and I have no doubt that as we move to the withdrawal of emergency cover, most junior doctors will say, “This is not something I went into medicine to do”, and will want to show their support for patients, rather than an increasingly militant junior doctors committee.

[Paula Sherriff (Dewsbury) (Lab)]

I plead with the Minister to respond to the comments from Jeremy Taylor, chief executive of National Voices, which represents 160 health and care charities and which has called on the Government to drop imposition and on both sides to get back around the negotiating table. In his words, if they do not,

“the only people who will suffer are patients.”

[Ben Gummer]

I disagree with the gentleman on two points. First, we have been trying to get around the negotiating table for over three and a half years, but it requires both sides to negotiate, and I am afraid the BMA has refused to do so. When only one party is at the table, negotiations cannot continue. Secondly, it is not just bad for patients; it is also bad for doctors in terms of their careers and what they want, which is to provide the best possible care for patients. That is why I urge all doctors not to withdraw emergency cover at the end of next month.

[Kevin Foster (Torbay) (Con)]

Does the Minister agree that whatever the dispute, the threat to withdraw emergency cover is one that nobody should condone, and will he join me in urging the BMA to withdraw the threat immediately?

[Ben Gummer]

I will join my hon. Friend. I only hope those on the Opposition Front Bench will also join him.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

The Minister has described those seeking to protect our national health service and their own work-life balance as being radicalised. Will he apologise for this insult to junior doctors and the English language and urgently seek a more consensual and inclusive resolution?

[Ben Gummer]

If the hon. Lady had been at the debate, she would know that I did not say that. It is important to understand that there is a wide gap between junior doctors and a few of the people who seek to represent them on the junior doctors committee, who have taken an increasingly militant view and whose motives, I would suggest, are not entirely in the interests of their members.

[Andrew Bridgen]

(North West Leicestershire) (Con): Given the BMA’s completely irresponsible announcement yesterday that it was willing to walk out on even emergency patients, which seemingly shows that the doctors union is willing to put patients’ lives at risk, will my hon. Friend look at how the law on emergency medicine could be brought into line with that for the Army and other such services to prevent emergency doctors from taking such irresponsible and appalling action in the future?

[Ben Gummer]

The new trade union legislation does not apply to doctors in the way my hon. Friend suggests, but I appeal to them and their consciences not to withdraw emergency cover and put patients at an increased risk of harm.

[Jim Shannon (Strangford) (DUP)]

In Northern Ireland, we have become experts in compromise and reaching agreement. We have had to come to terms with difficult issues and compromise on many things. The Northern Ireland Assembly Health Minister is in talks with the BMA and junior doctors to find a tailored solution for Northern Ireland that is affordable and has patient safety at its heart. Does the Minister not agree that it is time to get round the table, meet the BMA and junior doctors and realise that compromise between all parties can and often does reach a fair solution for all?

[Ben Gummer]

The contract is a compromise. We have compromised in a series of areas to try and reach a settlement, and 90% of it has been agreed with the BMA, but in the absence of talks—one party refuses to discuss the remaining items on a point of principle—we have to move ahead with implementation. That train has now left the station, and we will be bringing in the new contract later this year.

[David Mowat (Warrington South) (Con)]

Seven-day working was a clear manifesto commitment, and the BMA’s position is highly regrettable, but to implement it we will clearly need more junior doctors to backfill rosters, rotas and all that goes with it. For the avoidance of doubt, will the Minister confirm to the House that he has enough junior doctors to do that?

[Ben Gummer]

We are increasing the number of junior doctors and the number of other doctors, consultants and nurses over the next five year years in order to meet the increasing challenges facing our national health service.

[Andy Slaughter (Hammersmith) (Lab)]

The Minister said that he had reached agreement on 90% of matters, including some that were not on the table, and he is to be warmly congratulated on that. Perhaps he has a future at ACAS. What my constituents would like, however, is for him to go back to negotiate the other 10%. Is it not the case that the junior doctors want a resolution and have said that they will negotiate? The Minister should square the circle: he says they will not negotiate; they say they will. Will he give it one more chance?

[Ben Gummer]

The credit that the hon. Gentleman has kindly given me is due to Sir David Dalton, who achieved the 90% agreement on the contract. As for the remaining 10%, his judgment was that the junior doctors committee would refuse to negotiate. At that point, the Government had to make a decision about whether to proceed or to cave in. We decided to proceed, which is why we will implement the contract later this year.

[Liz McInnes (Heywood and Middleton) (Lab)]

I worked for the NHS for 33 years, so I know that NHS staff do not take strike action lightly. The Government’s failure to negotiate has fuelled this crisis in our NHS. The BMA said in its statement yesterday that it wanted to end the dispute through talks. I implore the Minister to get back round that table for the sake of patients and every citizen of this country.

[Ben Gummer]

Back in November, the BMA said that it wished to discuss Saturday pay rates, and then went back on that promise—one that it had made at ACAS. That is something that, in my experience, normal trade unions do not do. In my experience, they hold to their word when they have made a promise at ACAS. Given that repeated breach of good faith, it is hard to understand how a return to talks would achieve what the hon. Lady thinks it would. That is why it is so important to move ahead with the vast majority that has been agreed, and introduce this contract, which is better for patients and better for doctors.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

What an absolutely shambles of the Government’s own making! Will the Minister accept that in view of the language he is using today and the tone that the Government have struck—not just today, but throughout this week and before that—they have given the impression to junior doctors and the country that what they really seek is a fight and a confrontation rather than the resolution that the public deserve?

[Ben Gummer]

The hon. Gentleman is the last person to speak from the Opposition Benches. I note that he of all people—this saddens me—also fails to condemn this withdrawal of emergency cover. I am afraid that in the absence of that condemnation, the House will only draw the conclusion that the Labour party supports the withdrawal of emergency action in this strike.

[Liz McInnes]

On a point of order, Mr Speaker.

Oral Answers to Questions

Ben Gummer Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

10. What recent assessment he has made of staff morale in the NHS.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

The Department assesses staff morale in the NHS using engagement scores from the annual NHS staff survey. I am delighted to say that the engagement score currently runs at 3.78 out of 5, which is a rise from the position in 2012, when the survey began, when it was at 3.68.

[Dr Huq]

On top of the junior doctors debacle, the staff survey shows that midwives are stressed, with 90% of them working extra shifts unnecessarily. I have raised before the case of the radiographer Sharmila Chowdhury, who was sacked for exposing bribes at Ealing hospital, but has yet to get a practical response, other than the words, “Francis review”, which has yet to be implemented. When will the Government get a grip on plummeting morale in the NHS?

[Ben Gummer]

The hon. Lady asked a number of questions. On the specific issue about this particular member of staff, I know that my right hon. Friend the Secretary of State has met her, and I would be happy to discuss this further. The hon. Lady is wrong about the Francis recommendations, which are being implemented in full. She should look at the balanced results from the staff survey, with more staff saying that their motivation at work is going up, with the number recommending their trust as a place of work and as a place to receive treatment going up, and with the number able to contribute to improvements at work also going up. There are issues in the staff survey that we would like to address—it is unfortunate to see reports of bullying and harassment going up—but we are addressing the problem through the staff partnership forum, which I chair. Overall, however, this is a balanced and positive return from the staff survey.

[Andrew Bridgen (North West Leicestershire) (Con)]

Will my hon. Friend confirm that, as well as the importance of staff morale, we should note that in hospitals where seven-day working has been implemented, patient morale is also improving considerably?

[Ben Gummer]

My hon. Friend is right, and the returns from the friends and family tests across the country show increasing patient satisfaction with the NHS.

[Liz McInnes (Heywood and Middleton) (Lab)]

22. How does the Minister think that staff morale is affected when people hear the Government’s constant refrain of “implementing seven-day working”, particularly among pathology staff and others who have for decades provided a 24/7 service?

[Ben Gummer]

Despite the best efforts of Labour Members, staff morale has gone up over the past few years. The situation is not helped when the nature of the junior doctors contract is misrepresented, as it continually is by Labour Members. If they were to give a fair account of the contract to their constituents, I am sure we would see further improvements in staff morale in years to come.

[Nusrat Ghani (Wealden) (Con)]

Staff morale at Uckfield community hospital is exceptionally high, partly owing to its receiving 100% in a recent friends and family survey. Will the Minister join me in congratulating all the nurses, volunteers and front-office staff in Uckfield community hospital?

[Ben Gummer]

I happily congratulate the staff at my hon. Friend’s local hospital. This shows where good constituency representation, reinforcing the efforts of local people working in local hospitals, can produce improvements in staff morale and therefore in the experience of patients, which is something from which Labour Members would do well to learn.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

In a recent survey, 70% of GPs warned that their workloads were becoming unmanageable, and 55% said that the quality of the service they provided had deteriorated, with too few patients getting appointments, treatment and the range of services needed. We now hear reports of a large decrease in applications for GP training places, and this is one of the last cohorts to be fully trained by 2020. Unless the Minister takes urgent action to address these issues affecting GP morale, workload and recruitment, patient care will just get worse. What is he going to do about it?

[Ben Gummer]

The hon. Lady raises the issue of GPs. We are ensuring that there will be 5,000 additional GPs by the end of this Parliament, which addresses precisely the issues that she raises.

[Barbara Keeley]

indicated dissent.

[Ben Gummer]

I do not know why the hon. Lady is shaking her head. She asked what I am doing, and 5,000 additional GPs will help to solve her problem. Secondly, we are putting a greater proportion of funding into general practice, by comparison with the proportion of the NHS budget as a whole, than any previous Government. Thirdly, we are increasing the number of GP training places. I am pleased to report that we are doing well in ensuring that more people in training positions are choosing to become general practitioners.

[John Stevenson (Carlisle) (Con)]

12. What progress his Department has made on improving the performance of hospitals in special measures.

--- Later in debate ---

[Mary Glindon (North Tyneside) (Lab)]

14. What steps he is taking to ensure that people with muscle-wasting conditions who require a cough assist machine have access to such a machine, commissioned in the community by their clinical commissioning group.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

NHS England is working with Muscular Dystrophy UK through the Bridging the Gap project, and looking at issues such as the provision of cough assist machines, which are a local matter for clinical commissioning groups. A number of CCGs now have commissioning policies for these devices, based on a policy developed by Walsall CCG and shared nationally as an example of good practice by Muscular Dystrophy UK.

[Mary Glindon]

Twenty-one-year-old Freddie Kemp, who had muscular dystrophy, sadly died of cardiac and respiratory complications. He had been refused a machine by his CCG. The Minister said that he was working with Muscular Dystrophy UK. Will he meet representatives of that organisation to discuss what can be done to persuade CCGs to prioritise the provision of these important machines?

[Ben Gummer]

I thank the hon. Lady for bringing the matter to the House’s attention. Of course I will meet any groups who are concerned with it. I understand that the clinical evidence is divided in respect of the efficacy of cough assist machines as opposed to manual massage, but Walsall CCG has sought to resolve that—successfully, I understand—and other CCGs might wish to adopt its template. However, I will of course discuss with the hon. Lady personally the issues that she has raised.

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab)]

T4. I would like to express my sadness at the news that two people in my constituency lost their lives in a house fire yesterday. My thoughts are with their family and friends at this extremely sad time. The coalition Government legislated for NHS hospitals to earn up to 49% of their money from private patients. Arrowe Park hospital in my constituency is highly valued by local people for the service that it delivers, so for the sake of clarity will the Minister tell us whether he sees an increase in the number of NHS beds being used for private patients and a decrease in the number being used for NHS patients as a sign of success or a sign of failure?

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

The matter of private beds is entirely for the trust to decide, but we are very clear that NHS patients should always come first.

[Henry Smith (Crawley) (Con)]

T3. In the last decade, under the then Labour Government, Crawley hospital saw its accident and emergency and maternity units close. However, I am pleased to say that in recent years we have seen casualty services returning, as well as the introduction of a GP out-of-hours service and a greater number of beds. Will my right hon. Friend join me in congratulating the NHS staff in my constituency who are working so hard to deliver these new services?

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

I believe that the Capsticks governance review, published today, will show that serious harm was caused to patients and staff, that there was a culture of bullying and harassment even after the Francis inquiry, and that Liverpool Community Health NHS Trust is the community equivalent of Mid Staffs. In the spirit of openness and transparency, will the Secretary of State instigate a public inquiry to establish the full extent of the harm caused to patients and staff?

[Ben Gummer]

May I commend the hon. Lady for the brave stance that she has taken on this difficult issue? I will certainly take her concerns seriously. I want to read the report now that it has been delivered, and will speak to her at the earliest possible opportunity to establish how the Government and local commissioners can take things forward. It is imperative that the NHS has the best possible culture for how staff are treated and heard. I hope she will look at the announcement made by my right hon. Friend the Secretary of State about ensuring that people have the freedom to speak up and safe spaces in which to blow the whistle.

[Will Quince (Colchester) (Con)]

T6. At Colchester general hospital, insurance premiums under the clinical negligence scheme for trusts have more than doubled to £11.2 million in four years. What steps is the Department taking to reduce that figure?

[Ben Gummer]

My hon. Friend points to variations across the service. Premiums sometimes go up and down in different trusts. We are examining the whole scheme at the moment, and I am happy to speak to him further about what we are doing.

[Gavin Robinson (Belfast East) (DUP)]

Does the Secretary of State agree that this week’s public debate about breastfeeding has been destructive and condemnatory of women who suffer from post-natal depression and struggle to bond emotionally, never mind physically, with their children? Do we need to reframe the debate and reduce, rather than reinforce, the stigma for mothers who want to do the best by their children?

[Ben Gummer]

As my right hon. Friend the Minister for Community and Social Care, who is responsible for mental health, takes forward the increase in funding for perinatal mental health, he will want to work with me on breastfeeding rates and the relationship between breastfeeding and mental health that the hon. Gentleman correctly raises.

[David Tredinnick (Bosworth) (Con)]

T7. Is my right hon. Friend aware of the agreement struck by President Obama and Prime Minister Modi of India to collaborate on the research and development of traditional medicines for preventive and palliative cancer care? Should we not be aiming for a similar agreement, bearing in mind antimicrobial resistance?

BMA (Contract Negotiations)

Ben Gummer Excerpts

Monday 21st March 2016 Westminster Hall

[Catherine West (Hornsey and Wood Green) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David.

When someone decides to become a doctor, they do not expect it to be easy—there are years of study, huge student debts, antisocial working hours, and the pressure of knowing that the decisions they make every day can be the difference between life and death—but they have a right to expect that the Government will value and appreciate their training and dedication. Our NHS needs more doctors, not fewer. When we or our loved ones get sick, we all want the comfort of knowing that the brightest and best are providing their care, so the fact that we are having this debate means that today is a sad day. Although I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on introducing the debate, it is a pity that we have to have it. The Department seems determined to sabotage the relationship with junior doctors and is handling the negotiations poorly.

The contract has been described as unsafe and unfair. When I have met junior doctors from the Muswell Hill and Crouch End area we have spoken about how expensive childcare is, how they hope to be able to move out of their mothers’ and fathers’ houses, and how they hope to have a career and serve in the NHS. However, they feel that all of that is at risk. They are working every hour God gives them, but they feel that there is no genuine respect and that they will eventually find it very difficult to remain in London, purchase a home and continue to serve in the NHS. They are even thinking of trying to work abroad. There is a real risk that the Government’s approach will take us back to the bad old days of overworked doctors who are too exhausted to provide safe patient care.

One doctor told me that they had £40,000 of student debt after six years of training and were just starting out on a salary of £22,600. They said that the reclassification of unsocial hours would see them lose about 30% of their salary and leave them struggling to pay their rent and bills. The new contract that has been imposed will see incomes fall by 20%—

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

That is not true.

[Catherine West]

If it is not true, I look forward to clarification from the Minister. We would not like to see a couple who are junior doctors having to leave their jobs because the cost of childcare is more than it pays to work as a doctor.

The situation is turning into a shambles. I hope that the Secretary of State for Education is watching, so that last week’s big announcement about the reorganisation of education does not end up in a similar situation in a year or two. First millions of pounds was wasted on an unnecessary top-down reorganisation, then staff and patients were made to pay the price of the Government’s financial mismanagement. Will the Minister clarify whether 75% or 80% of trusts are currently in deficit? We are already in the middle of a workforce crisis, so the last thing we need is more doctors leaving. I have heard that 1,644 physicians have registered with the General Medical Council for certificates to allow them to work overseas; will the Minister clarify the exact number? The GMC normally receives only about 20 applications a day, but since Christmas, with the Government’s disastrous handling of the situation, the number has shot up.

I have written to the Secretary of State to urge him to get on and sort out the situation. The Government have to accept that compromise is necessary. As my hon. Friend the Member for Hammersmith (Andy Slaughter) said, there is a deal to be done. Why put patient safety at risk when it is really not necessary? I was proud to stand in solidarity with the fantastic junior doctors at my local hospital, Whittington hospital, as well as those at North Middlesex hospital on the other side of my constituency. There really does seem to be a lot of willingness to talk; I just hope that that is reflected in the approach of Ministers.

The Government’s current approach is wrong. They should be much more flexible, and they should want to open negotiations and talk rather than impose things. Junior doctors are vital to the future of the NHS, and it is clear that if we want to move towards a seven-day NHS and improve patient care, we have to ensure that the staff we rely on are supported and valued. It is deeply worrying that the BMA has described the contract as “unsafe and unfair”, and that the Royal College of Paediatrics and Child Health has stated that it could be

“gravely damaging to the health and wellbeing of children”

and could

“adversely affect recruitment, retention and the morale”

of junior doctors. I look forward to hearing the Minister clarify those points.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a pleasure to serve under your chairmanship, Sir David, and it has been a pleasure to hear some of the contributions to the debate, which have included measured speeches, as ever, by the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), and the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford). However, it disappoints me as much as it does many other hon. Members that we need to be here today. We would all have wanted the issue to be concluded some time ago. I hope that in the next few minutes I can describe why we are in this position and what we plan to do about it.

I will start by discussing something that the hon. Member for Hammersmith (Andy Slaughter) touched on, because I know he wants to leave early. I want to make these comments before he does. We are all here because we are interested in the future of the NHS, but, among various silly outbursts and fits of laughter, he described the speech of my hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) as tragic. There is indeed tragedy behind my hon. Friend’s interest in patient safety, and that is that her father died as a result of a failure of patient safety. It is no coincidence that she is here today and that she cares so much about this important issue. It behoves hon. Members, and especially the hon. Gentleman, who is barely able to contain himself on matters of this kind, to pay a little attention to the motivations of Members, on whichever side of the House they sit, and the reasons why they feel strongly about the matter. That includes the Secretary of State, who considers it to be a question of patient safety through and through. A portion of that is about the delivery of seven-day services, but more broadly, to reflect on the wise words of the hon. Member for Central Ayrshire, it is about the fact that tired doctors who work bad rotas are dangerous. That is at the core of our reasons for wanting to change the contract.

It was not just the present Government who decided that it would be right to change the contract. It was the British Medical Association that confirmed, in 2008, that the contract was not fit for purpose, just a few years after the Labour party had introduced it.

[Andy Slaughter]

rose—

--- Later in debate ---

[Ben Gummer]

I will not give way, because I know the hon. Gentleman has to go, and he intervened enough earlier.

Far from a few minor amendments, as the hon. Member for Warrington North (Helen Jones) suggested, a far greater number of changes needed to be made to the contract.

[Helen Jones]

I am afraid the Minister may be misquoting me. I was giving examples, not suggesting that they were the whole list of things wrong with the contract. When I said there were only a few issues, that was to illustrate that the Government and the BMA are not that far apart in the negotiations. Perhaps the Minister will consider what I actually said.

[Ben Gummer]

I will, and by way of return I hope that the hon. Lady will consider what the Secretary of State has actually said on a number of occasions, which—I am sure completely unintentionally—she misrepresented at numerous points. The hon. Lady said that the existing contract had moments of imperfection—I cannot remember her exact words. However, it had rather more imperfections than that, which is why the BMA recognised many years ago there was a need for significant change, and why the coalition Government entered into negotiations with the BMA early in 2013. The heads of terms were agreed between early 2013 and July 2013. The negotiations began in October 2013 and broke down a year later, with no notice to the Government. The BMA just walked out, and it took some time to explain why. It claimed, generically, that it was to do with patient safety, which was an odd thing to say given that there were doctors negotiating on the management side who were also concerned about patient safety. The negotiations were not rejoined until we involved ACAS in November last year.

[Dr Whitford]

When we had a debate about the issue in October, the Secretary of State was reluctant to go to ACAS, yet only when the negotiations went to ACAS was some progress made. The BMA wanted the contract changed to include recognition of quality training. The junior doctors are future consultants and leaders, and at the moment, while they hold multiple pagers and cover rota gaps, they feel that they are getting no training at all.

[Ben Gummer]

I will come on to the hon. Lady’s sensible points about rota gaps, which have persisted for many years and need to be addressed as a separate issue, and about training. However, the negotiations have been going on for more than two years. There is an idea that the Secretary of State somehow ended them peremptorily, but throughout the period of the negotiations there was a serious attempt to engage with the BMA. Progress was very slow, and the BMA unilaterally broke off the negotiations in October 2014. It did not come back to the table until the offer was made to go to ACAS.

On why the Secretary of State took the stance that he did, I have a different interpretation from the hon. Lady, because I was with him through that whole process. We were very keen to return to negotiations via ACAS, but we needed to ensure that the BMA would give its representatives full negotiating powers.

[Justin Madders]

Will the Minister give way?

[Ben Gummer]

I will in a second; I will just answer this point.

From that point, as many Members have pointed out, considerable progress was made through the negotiations that we had under ACAS from December 2015 to February 2016—far more progress than in the previous negotiating period, partly because the BMA knew that an imposition would have to come if there could be no agreement. As the shadow Minister will understand, at some point an employer needs to move both on issues where there is agreement and on those where there might not be.

The fact that the Secretary of State chose Sir David Dalton to lead negotiations undermines the argument that somehow he was not trying to come to a negotiated settlement. He asked one of the very best chief executives in the NHS to lead the negotiations on his behalf. Even Sir David Dalton was unable to come to a final conclusion of the negotiations with the BMA, because the BMA refused to discuss the last remaining substantive issue—the rates of Saturday pay.

Herein lies the rub: in the heads of terms of the talks it began through ACAS, the BMA had agreed to discuss Saturday pay rates, yet it withdrew that agreement at the end. Sir David Dalton was therefore forced to write to the Secretary of State saying that in his judgment, there was no prospect of agreement on the remaining matters because the BMA was refusing to discuss them. When the Secretary of State or any negotiator has no counterparty with whom to negotiate, it is impossible to negotiate.

Far from the title of the e-petition, which suggests that the Secretary of State has somehow been unwilling, he has been negotiating in good faith all through the period since 2013. It was the BMA, right at the last minute and at previous moments that has refused to do that. I myself have called on it a number of times, both personally and in public, to come back to the negotiating table.

[Andy Slaughter]

Will the Minister give way?

[Ben Gummer]

I will not, because I know that the hon. Gentleman needs to go. I said that I would give way to the shadow Minister.

[Justin Madders]

The Minister is correct that considerable progress has been made in negotiations since the start of this year. The consensus seems to be that 90% of the contract was agreed. Does he not agree that it was therefore a great shame that a decision was made to impose the contract when just 10% of the issues were outstanding?

[Ben Gummer]

It is a great shame that we were unable to discuss those final things with the BMA, but as I have just explained, the BMA did not wish to discuss that final portion, even though it had agreed to do so in the heads of terms that were in front of ACAS at the end of November 2015. It was impossible to have that final discussion. That was not of the Secretary of State’s volition; it was a decision of the BMA’s junior doctors committee.

I turn to the point that my hon. Friend the Member for Morley and Outwood made, which Opposition Members discounted so quickly. At no point has the Secretary of State ever claimed that there is militancy among junior doctors as a whole, nor has he said that the BMA as a body has sought to wind up the dispute. In fact, if he had said that, it would have been entirely wrong. It is, however, true that the junior doctors committee, which is a small portion of the BMA—it is not the whole body, and we have just come to an agreement with the BMA on the general practitioners’ contract—has become radicalised in the past few years.

We know that the committee did not wish to discuss Saturday pay rates, not because of any inherent merit or otherwise in the arguments but because of the tantalisingly close prospect of an agreement with the Secretary of State—one that the committee had been fighting against. We know that that dispute existed, because even when we made a revised offer just after Christmas, the committee refused to discuss it before talking to its members and committing to a strike. There has been an impelling force within the junior doctors committee to take action, which, I am afraid, has disrupted the course of the negotiations and made it far harder to have an open and honest discussion with junior doctors.

We come to the issue of junior doctors being misled. They are very bright people who I know take an interest in the news and in the contract under which they will be working. I have no doubt about that. However, the British Medical Association—a trusted body—has claimed to its members that they are going to have a pay cut of 20% or 30%. Despite the fact that the NHS and we in this House have rejected that claim numerous times, it has been repeated. The hon. Member for Hornsey and Wood Green (Catherine West) repeated it today. That claim is untrue. It was made in the summer, and it is no wonder that BMA members were worried. If I were a junior doctor and someone told me I was going to have a 20% or 30% pay cut and would have to work longer hours, I would be extremely worried, and of course I would be angry. The fact is, however, that the claim was not true. The gravity of that untruth is such that it can still be repeated in this Chamber as if it were true.

Junior doctors, who no doubt informed the hon. Lady—I know she is not willingly misleading the House—still think they are going to have a pay cut of 20%. If we are still in an atmosphere where people believe they are going to have something that they are not, and that they will have to work more hours than they will, it will of course be difficult to come to a resolution until we allow things to calm down. That is why it is important to move to a point where junior doctors have the contract in front of them, so that they can see the effect on their working patterns and see that much of what they have been told is simply not true. We can then, I hope, move to a much better position in individual trusts where we can start discussing the existing problems that the hon. Member for Central Ayrshire mentioned, such as rotas, training schedules and the like.

I will address some of the individual points that hon. Members have made during this interesting debate. Apart from misrepresenting the shape of the negotiations as if somehow the Secretary of State had broken off talks, which he did not, the hon. Member for Warrington North questioned the research that led to the various statements that the Secretary of State and others—many of them clinicians—have made about the so-called weekend effect, or avoidable excess mortality attributable to weekend admissions. I should make absolutely clear where the link is. Almost any clinician in the NHS will recognise that we do not yet have the same consistency of care over the weekends that we do during the week in every hospital or every setting where we need it. We know that, and the hon. Member for Central Ayrshire made a similar point herself.

Our manifesto pledge was translated into the mandate that is reflected in all the contract negotiations that are going on, and it concerns one particular issue—the need to standardise urgent and emergency care—and nothing more. It is not about elective care; I have made that point several times to the hon. Lady. People who are admitted at weekends—including, to some extent, those admitted at the shoulder periods at the end of Fridays and especially on Monday mornings, because of inconsistency of care over the weekends—will then be able to expect the same standard of care, which will contribute to lower mortality rates as part of a wider package to reduce mortality attributable to weekends.

The drive for that comes from clinicians. It comes from the seven days a week forum convened by the Academy of Medical Royal Colleges, which reported at the end of 2012 and gave the Secretary of State and the whole service 10 clinical standards that it believed would help to reduce variation in weekend clinical standards. It is those standards that we seek to bring in across the service. The academy has said that four of them in particular are the most important for reducing variation. They relate to urgent and emergency care, and it is those standards that we seek to fulfil across the service.

[Helen Jones]

The Minister is once again managing to conflate two things. Everyone accepts the need to improve emergency care at weekends. What is not accepted—this is where the Secretary of State misused the research, and I was questioning his use of it, rather than the research itself—is a causal link between junior doctors’ work patterns and the deaths that occur. That is simply wrong; the research does not show that. In fact, a great deal more research is needed to find out the actual causes of the excess mortality.

[Ben Gummer]

If the hon. Lady were quoting the Secretary of State correctly, he would indeed be wrong, but he has never made a causal link precisely with junior doctors’ working hours. He has said that it is the working patterns of the NHS as a whole. One of the studies that the hon. Lady quoted in part makes it clear that the purpose of the research study was not to look at answers to the questions that were raised, but it did say that one of the areas that policy makers should look at first is staffing ratios over the weekend.

Let me ask the hon. Lady something. There is general acceptance across the service of a weekend effect. There are varying studies that, under different research scenarios, point to figures of 6,000, 8,000 and 11,000 deaths, and sometimes more—15,000, for example. Does she believe that if the number were 2,000, it would therefore not be right to deal with this problem? Would 500 be an acceptable number of deaths that we should tolerate without seeking to reform contracts? In fact, what price should we put on an avoidable death? Or is she saying that not one single death in the service is related to staffing ratios over the weekend?

[Helen Jones]

The Minister is once again managing to conflate two different issues. Let me repeat what the researchers said:

“It is not possible to ascertain the extent to which these…deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

That is the researchers’ comment on their own research. Of course, nobody wants to see preventable deaths, but the Secretary of State has tried to use the research to link those deaths to junior doctors’ working patterns. It simply does not prove that. He is wrong.

[Ben Gummer]

I will happily arrange for the hon. Lady to have a clinical explanation of the various studies that she has cited, because I think she will then understand why the part that she has quoted needs to be understood in context—[Interruption.] I am asking her a direct question: does she—and do other hon. Members, who are tittering about this on the Opposition Benches—really propose that there is no weekend effect? If they are saying that is the case, or if they are saying that there are 500 or 1,000 deaths and that somehow is acceptable and the Secretary of State should not address himself to it, that is a worrying statement of intent.

[Dr Whitford]

rose—

[Helen Jones]

rose—

[Ben Gummer]

I will not give way to the hon. Member for Warrington North. I give way to the hon. Member for Central Ayrshire.

[Dr Whitford]

The problem here is about exactly what it is the paper shows. What do any of these papers show? They show a statistical excess of deaths. We know that 25% more of the people are in the sickest category. We know that 15% more of them die on a Sunday. Maybe the NHS did an absolutely amazing job in saving the other 10%. We do not know the answer, so we do not know how many are avoidable. However, I would point out to the Minister, who referred to the standards, that the only mention of junior doctors in the 10 standards is with regard to review of outcome and focus on training. Not one of the 10 standards says there should be a change in how junior doctors work.

[Ben Gummer]

One of the studies that the hon. Lady cites does a control for acuity, which she has raised. I know that there is an understandable change in the acuity of patients and one of the studies allows for that.

As for the point about the 10 clinical standards—and here I will just move on from the points that the hon. Member for Warrington North was making—

[Helen Jones]

Before the Minister does, will he give way? He asked me a direct question.

[Ben Gummer]

I will in a second, but hopefully I will answer the hon. Lady’s point first. She says that I am conflating two things, but I am certainly not; I am saying that there is a recognisable weekend effect. We can have a discussion about the precise numbers involved, but the key answer is that clinicians themselves understand that something needs to be done to reduce variation. I will come to junior doctors in a second, but clinicians themselves have offered the 10 clinical standards, which lie at the base of this. We are not doing anything extra beyond what clinicians are recommending. The four key clinical standards lie at the heart of our changes to urgent and emergency care to ensure consistency of standards, and it is right that one of them relates to the training of junior doctors. The standard at the moment is not as good at the weekend, because they do not have consultant cover, and that is something we are hoping to change. It is also true that the 10 clinical standards refer to senior decision makers, and there is a discussion about precisely who that might be. I will give way to the hon. Lady now, and then we will move on.

[Helen Jones]

Had the Minister listened to what I said, he would have heard me say that there is a weekend effect, even when the control for acuity is put in, and that more research is needed to find out exactly why that occurs. No one on the Opposition side wants to see preventable deaths in the NHS, but the Minister has to explain why this contract that he wishes to impose is so important in preventing them, when many trusts have already managed to improve weekend working—including Salford—without it.

[Ben Gummer]

On the issue of the response to the mounting clinical evidence of a weekend effect—I am glad that the hon. Lady recognises it—clinicians have said that we need to reduce variation by changing the clinical standards that we hold clinicians to, and that is what we are seeking to do. That is why all the contracts relating to clinicians are being reformed. It is part of a package. I have made that point in this Chamber many times before, so Members who keep repeating that somehow we are loading everything on to junior doctors are just not listening to the points that the Government are making—that it is part of a piece.

The recommendations of the DDRB—the Review Body on Doctors’ and Dentists’ Remuneration—asked for far more radical changes to Saturday working. We have moderated those in an effort to bring about negotiations and discussions with the British Medical Association, but it has refused to do that.

I will answer one more point that the hon. Lady made in her speech. She said that a point of contention was payments and reward for length of service. I think she was referring to increments. That issue was resolved with the BMA as part of the 90%, so I hope she therefore sees that it is not a substantial part of the argument, despite what she pretended.

The hon. Member for Wirral West (Margaret Greenwood) mentioned issues around psychiatry, which was a legitimate point to make. That is precisely why, as part of the new contract, flexible pay premia will be paid to psychiatrist trainees, so that we can provide an incentive to get more trainees opting for this specialism. It is clear that across the service, there are specialisms that, for decades now, have not recruited the numbers that we would all like to see going in. We have identified three where we think a particular incentive is appropriate, because of the difficulty of going into those specialisms—general practice, emergency medicine and psychiatry. This is one that we proposed. It was disagreed with and then agreed with by the BMA, and we hope, therefore, to address precisely the point that she made in her speech.

[Dr Whitford]

Will the Minister clarify whether the protection for GP registrars has been re-established? We obviously do not have access to the terms and conditions that have been agreed, because they have not been published. However, one of their concerns was that they had pay protection when they became GP registrars, and that was going to be taken away.

[Ben Gummer]

All trainees working within legal hours will have pay protection and that includes GP registrars. That was one of the bottom lines of our negotiations all the way through the process and precisely why we are so disappointed that the BMA consistently misrepresented our position.

I have addressed the point the hon. Member for Hornsey and Wood Green raised about the 20% fall in income. She asked me to say expressly whether that is right or wrong. It is wrong. No one will see a fall in their income if they are working the legal hours. Indeed, we think that 75% of doctors will see an increase through the course of this pay contract.

The hon. Lady raised the issue of maternity and cited a doctor who claimed that they were earning £22,600. I would be interested to know the detail of that because the foundation year one minimum pay rate is £23,768, which is slightly above the figure she quoted. She made an entirely valid point about the need to make sure that women especially, but I hope under shared parental arrangements, women and men in the service have the flexibility to be able to take time out of the service to bring up children. That is why the increased base rate of pay is particularly good because it will increase the parental pay, as we should now call maternity pay, under shared parental leave when people take time out to look after children.

The hon. Member for York Central (Rachael Maskell), who is no longer in her seat, talked about guardians, but was factually wrong to claim that there would be no payment to junior doctors. They will be able to get one and a half times their salary as part of the payment fines made to guardians. The guardians will not, as the hon. Lady suggested, just respond to complaints. They will have an overall duty to maintain the wellbeing of junior doctors. Theirs will be a critical position in trusts and I hope it will grow into being a substantial one, making sure juniors have the opportunities for training they wish for and the levels of welfare to which they are entitled.

The hon. Lady spoke about whistleblowing, and her comments concerned me because this is precisely an area where we should be asking juniors to speak up. If working longer hours is dangerous—we all agree with that—like any other patient safety issue, not only should they morally speak up to their guardian, but they are under a duty to do so under GMC guidelines.

[Dr Whitford]

Does the Minister recognise that if someone is the most junior person in a very hierarchical system, it is difficult and harder for them to complain about something they perceive is being done to them as opposed to something they see concerning a patient?

[Ben Gummer]

I recognise that speaking up is difficult in the current NHS culture. It is precisely what lies at the heart of Sir Robert Francis’s second report. That is why we need to change that culture. It is also the reason why we said that guardians, in receiving proactive complaints from juniors, should have an overall duty of care for the juniors in their trust and make sure they are treated properly. That is why this is an exciting role. It is a tutorial role in sense with a responsibility, especially for the youngest trainees, to make sure they are in the right place and supported in what can be difficult times.

[Dr Whitford]

May I ask the Minister again about not having the chance to see the details? One concern of junior doctors is that they would not have a voice or a role within the guardianship. They asked to have a representative as part of that function. Has that changed, or are they still excluded from that?

[Ben Gummer]

They are not excluded. It is important that that person does not become a BMA nominee, but we want the guardian to make sure they command the respect not only of the junior doctor workforce, but the trust itself. It is important to make sure that person gets that degree of buy-in from both sides, and I hope that the final solution we arrive at will satisfy that.

[Catherine West]

Does the Minister agree that, traditionally, whistleblowers have not been treated respectfully and that perhaps the current approach of imposing things is not the right step forward in changing the culture?

[Ben Gummer]

There has been a problem for decades with whistleblowers being listened to. That is what gave rise in part to the tragedy at Mid Staffs and the Secretary of State is trying desperately to do something about it. He cares passionately about it and his recent speech, which the hon. Member for Lewisham East (Heidi Alexander) welcomed, was about trying to create those safe spaces within trusts so that people feel they can speak openly. Indeed, recently at the social partnership forum, which I chair and where we hear contributions from trade unions, I heard of a very effective scheme recently developed in Somerset which showed a good way of getting people of all grades in a trust able to speak up.

I, too, am delighted that the hon. Member for Bristol West (Thangam Debbonaire) has been able to take her seat again. She has come back at an exciting time in politics—one that may be more exciting for her than the last six months. She asked about the funding for seven-day services. All I would say is that within the five-year forward view are two parts that are connected. The first is the commitment to have seven-day services in urgent and emergency care, which is reflected in our mandate for the service, our manifesto pledge at the last election and the request for £8 billion of cash funding connected with the £22 billion of efficiency savings in the service. That is the funding that is being provided to achieve not only that commitment, but everything else in the five-year forward view. Hon. Members have questioned whether that money is sufficient and I point them to the statement by NHS England today in which it was very clear that that is the amount that was asked for and that is the amount that they were glad to get.

The hon. Member for Central Ayrshire spoke about the opt-out, and I want to give clarification for the record to ensure that we are clear about it. In parts of the emergency care pathway, the opt-out has an effective impact and indeed affects part of the urgent care pathway. Ensuring the opt-out is removed is one of the areas we are keen to progress and was the origin of the Secretary of State’s statement, which related to that and not to junior doctors at the beginning of this process. It is important that we do that specifically around urgent and emergency care, and other hospital services, but we have never, ever wanted to extend by the process of our negotiations elective care at weekends. That is not part of our commitment, which has always been squarely about ensuring consistency of standards in urgent and emergency care.

[Dr Whitford]

I am afraid that I have sat in the House and listened to the Secretary of State talking about having elective services across seven days and how great that would be for patients. Of course it would be great, but we would need thousands more doctors whom we have absolutely no chance of finding. It has not been clear. In Salford Royal today, Sir David Dalton again said one crucial thing is for the Government to define exactly what they mean by seven days. Doctors have not objected to strengthening urgent and emergency care.

[Ben Gummer]

The hon. Lady, in repeating that, as have other hon. Members, makes it harder for us to state again—she knows I have done so on numerous occasions—that this is to do with urgent and emergency care. It is true that some hospitals—Salford Royal is one—do elective work at weekends. I have no doubt her hospital might do some elective work at weekends. That is part of the trust’s decision-making. It is for the hospital to make that decision. Our key in changing these contracts has been to concentrate on urgent and emergency care. That is the focus of the contract changes.

The hon. Lady also spoke about the tenor of the language that has been used and I know that she cares deeply about this, for understandable reasons. I, too, enormously regret the way this has been portrayed. Although to a lesser degree than the Secretary of State, I have been on the other end of language that one would hope professional doctors would not wish to use.

The whole debate has become intemperate in an extremely unfortunate way, but I have sat through every single speech that the Secretary of State has made on this matter and every single press utterance—I have also made a number myself—and never once has he attacked junior doctors as a body. He has only the utmost respect for them, not least because, like everyone else in this Chamber, he has been the beneficiary of their care. But it is true that they have been let down by their trade union.

I repeat—I know that the Opposition Front Benchers know this—that the BMA has let down its members, because first, it has allowed a series of statements to persist that it knows to be untrue, and secondly, the junior doctors committee has not engaged in meaningful negotiations in the way that it should have done and in the way that other parts of the BMA have been happy to do, and they have concluded better contracts as a result.

That brings me to the points that the shadow Minister, the hon. Member for Ellesmere Port and Neston, made. He asked quite a lot of questions, and I commit to giving a full answer later to the ones that I do not answer today.

The hon. Gentleman asks whether there will be any further steps to avoid industrial action. We will do whatever we can to ensure that junior doctors understand the nature of the contract, and we hope that they will therefore not feel the need to go on strike. We have contended all the way through that that is a needless endangering of patient safety. It is certainly a massive inconvenience to patients, many thousands of whom have now seen their operations cancelled as a result. The contract dispute does not have anything to do with safety, as the BMA itself has implicitly accepted. It is to do with Saturday pay rates. The BMA and its members really have to think about whether they wish to take the dispute about Saturday pay on to the street time and time again.

The hon. Gentleman asked whether there has been a risk assessment on patient safety. We have risk-assessed that at every single stage, and the way in which we have dealt with the industrial action has been concentrated solely on the effect that it has on patient safety, but the best way of ensuring patient safety is for the BMA to cease its unnecessary action.

In relation to an assessment of recruitment and retention, the whole contract has been framed to try to ensure that doctors have a better work-life balance. That is precisely why we have reduced the number of consecutive long days, consecutive long nights and consecutive weekends, and it is why the contract is better for junior doctors and why we hope that it will aid recruitment and retention in the long term. However, we are conscious of the fact that there are ongoing morale issues that go all the way back to 1999 and beyond. In fact, when the previous contract was negotiated, precisely the same points were made about morale as are being made now, so clearly the old contract did not fix those issues. That is why we have asked Professor Dame Sue Bailey to look at wider issues of training and morale in the service as they pertain to junior doctors, to see what else needs to be done to ensure that they are getting the training opportunities that they require, the welfare standards that they expect and the quality of work-life balance that they rightly wish to have.

The hon. Gentleman asked about the BMA’s proposal that it claimed was cost-neutral. Our judgment was that it was not cost-neutral, and given that the BMA was refusing to negotiate on the contract that was on the table and had been worked on for several years, it was rather odd—and, one might think, a political gesture—to throw an entirely new idea on to the table, knowing it not to be cost-neutral. I would say that that was more for effect than to actually try to further the aims with which everyone approached the contract renegotiation.

In short, I am afraid that I reject the premise of the petition, because the Secretary of State has attempted at every stage in the process, over a period of nearly three years, to have meaningful contract negotiations with the BMA. At every point at which contract negotiations have broken down, it has been the instigator of that breakdown, so the petition would better serve itself by being addressed to the junior doctors committee of the British Medical Association, which has broken off meaningful contract negotiations not just once but three times. It is with that committee that the responsibility lies for the failure to find a solution to the final 10% of the contract negotiation, as Sir David Dalton concluded.

[Justin Madders]

I am grateful to the Minister for giving way; I could tell that he was about to reach a crescendo. He has set out what he intends to do to reduce the temperature and avoid further industrial action. I have to say that I think his response was inadequate, but his central contention was that he hopes to persuade the majority of the BMA’s membership that the new contract is beneficial for them. To that end, can he confirm when the full details will be publicly available?

[Ben Gummer]

I expect the full details to be available shortly. The Secretary of State is studying, and will continue to study, the draft final terms, together with the equality impact assessment. It is important that when he has studied that assessment, he can make a judgment about whether any changes are necessary. Once that process has concluded, the final offer will be made, and that will be the point at which we proceed with the implementation of the contract. I hope very shortly to be able to give the hon. Gentleman a timetable for that. It is in my interests as well as his to see it happen as soon as possible, and I hope to be able to provide junior doctors with the reassurance that the contract will provide—that this is not the tragedy that they have been led to believe it is.

This has, none the less, been a difficult period for the service and, in particular, for junior doctors, who have been led to have unnecessary worry as a result of a series of misrepresentations by their union. I hope that in the next few weeks and months we can allay their concerns, and I hope that we can then get on with the job that we are all mindful of the need to achieve, which is better quality of care whatever the day of the week, a reduction in avoidable mortality whatever the cause, and an improvement in our national health service.

[Helen Jones]

Sir David, I apologise for demoting you to the ranks in my opening remarks.

This has been an interesting debate, although I was disappointed by the Minister’s reply. He is normally a very reasonable man, except when he is attributing things to Opposition Members that we have not actually said. His problem is that he is being sent here time after time to defend the indefensible. It is clear that there is a deal to be done, as Opposition Members have said, but there is no movement from the Government to get people back around the table to do that deal. If the contract is so good that it provides a land of milk and honey for junior doctors, as the Minister seems to imply, one wonders why they are not dancing in the street at the prospect of it.

We have heard clearly from Opposition Members about junior doctors’ worry that the contract will lead to excess hours and that they are moving from being part of a team, where they learn and progress properly, to being just another rota of shift workers to be shifted around. We heard from my hon. Friend the Member for Bristol West (Thangam Debbonaire), whose return I too am very glad to see, about her experience in the NHS and the staff who went the extra mile for her, and we have heard about the weekends that people work.

We have also heard some extraordinary attacks from Government Members on a respected profession. I understand that the hon. Member for Morley and Outwood (Andrea Jenkyns) may have suffered a personal tragedy, but that does not in any way justify her attempts to smear all junior doctors as a bunch of militants who are endangering patient safety.

[Ben Gummer]

She did not say that. Withdraw.

[Helen Jones]

Yes, she did say they were endangering—

[Ben Gummer]

She did not say that. Withdraw.

[Helen Jones]

She did. She said they were Corbynites—

[Ben Gummer]

Withdraw!

[Helen Jones]

No, I am not going to withdraw that remark. [Interruption.]

Mid Yorkshire Hospitals NHS Trust

Ben Gummer Excerpts

Monday 21st March 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the hon. Member for Dewsbury (Paula Sherriff) for bringing this matter to the House and for her powerful introduction to her constituents’ concerns. I also thank the hon. Member for Batley and Spen (Jo Cox), who intervened. They make a powerful double act for Mid Yorkshire. I have felt the pressure of the concerns they have quite rightly raised with me privately, and I hope that they will be able to do so again in the next couple of weeks.

I very much like the fact that the hon. Member for Dewsbury ended by mentioning this important anniversary. We are a few weeks away from the 70th anniversary of the Second Reading of the National Health Service Bill, as it then was, on 30 April. At that time, Nye Bevan made two points about the introduction of the NHS. The first is the one we all know, and of which we are equally proud, which is that it should be a service free at the point of need.

However, Nye Bevan made another point, which for him was as important in the establishment of a national health service—it has been forgotten by politicians on both sides during the past 70 years—which is the principle of universalising the best. He made a very powerful argument at the time, which was that the reason for a universal NHS was to ensure not just that people could approach the service without having to worry about money, but that someone from a part of the country that traditionally did not have good hospital care could rely on the same quality of service that they would expect in a wealthier or better served part of the country.

In establishing the first part of Nye Bevan’s dream, we have done well, but in establishing the second part, we have not yet succeeded. The hon. Lady’s constituents have, in part, been at the rough end of that. For years, under Governments of all kinds, we have not done well enough in universalising the best across the service. As we discussed when we had our meeting, there are hospitals not far from hers that are delivering exceptionally good and consistent levels of nursing care. They have been able to do so while under similar pressures to those in her own hospital—as she has correctly identified, similar pressures apply across the service.

Clearly, there are historical problems in Mid Yorkshire, and they will be difficult to grapple with. I completely understand why the hon. Lady feels that commissioners might not yet have a full enough grasp of the problems in her area. That is why she questions the basis of the reconfiguration. I understand that the assurance exercise into the reconfiguration is nearing its end, and we will publish that at some point in the near future. I hope that that will provide assurance that the accelerated reconfiguration can take place. I take into account the completely legitimate points that the hon. Lady made about the readiness of the reconfiguration of social care services in the area, but I think we should cross that bridge when we get to it. I am mindful of the fact that I have no power to change reconfiguration decisions—and neither does the Secretary State.

[Jo Cox]

As the Minister will be aware, the Mid Yorkshire Hospitals NHS Trust has the third highest number of admittances to A&E in the country. In that context, I share the concern of my hon. Friend the Member for Dewsbury (Paula Sherriff) about the planned reorganisation and downgrade of the Dewsbury hospital. It is a serious matter for local residents and some of my constituents. It would be wonderful to have a commitment further to discuss whether now is the time to move forward with that plan.

[Ben Gummer]

Of course I understand why it is a matter of concern. I must say what I have also said privately, which is that I must respect the opinion of clinicians and commissioners. That is why I want to hear what they say. Ultimately, there is the approval process that this reconfiguration has already gone through—namely, that of the Independent Reconfiguration Panel. I will, of course, speak to the hon. Lady whenever she wishes. It is not kindness on my part, but my duty to her as a Minister responding to an elected representative.

I spoke today to the director of nursing at the Mid Yorkshire Hospitals NHS Trust and also to representatives of the local trust development authority, and I was glad to be assured on some points. I was pleased to hear that they were co-operating with Lord Carter’s review of safe staffing ratios, which should provide a promising foundation for ensuring that we have the right kind of staffing ratios at the appropriate acuity of patients. This will be good in every hospital where it eventually applies, but for those with very challenged staffing ratios at the moment, the ability to look carefully at the rostering of staff across the service with the kind of skills and international experience that Lord Carter will bring will, I think, be helpful. Unfortunately, I was not made aware of the meeting that the hon. Lady had with the chief executive. I am disappointed about that because she clearly had a robust discussion. I have seen the contents of the letter that she sent to the Secretary of State.

[Paula Sherriff]

Given that Ernst & Young’s services were used, at some considerable cost, and that some of the matters it considered were staffing issues and staff forecasts, it is relevant to point out the contract has now ended after about four or five years. Does the Minister agree that it is quite worrying to find ourselves in this position after spending somewhere in the region of £15 million?

[Ben Gummer]

As a constituency MP, I, too, have been frustrated by consultancy contracts, both before and after the 2010 election. Across the service, we have managed to bear down on consultancy spend considerably. It is for the hon. Lady and her consultants to determine whether the trust has got good value for money. It is not for me to pass comment on that, except for the fact that all hospitals should account to their local people and to the trust and local authority responsible for making sure that money is being spent wisely.

I completely agree with the hon. Lady in that behind the statistics of poor performance that she identified, there are people who are not receiving the care they require. That was picked up by Professor Sir Mike Richards in his report into the quality of care provided at the hospital. He was very clear about it, saying

“we found medical care, end of life services and community inpatients either hadn’t improved or had deteriorated since our last inspection.”

He found areas of significant staffing shortages affecting patient care, especially on the medical care wards, community in-patient services and in the specialist palliative care team. He said that there was a shortage of medical staff for end of life services. He came to the same conclusion as the hon. Lady did.

The difference here is that I hope we have made progress since the Mid Staffs tragedy that the hon. Lady identified, and are now able to be more open about this. There will not be a culture of denial from the Government Benches about problems where they exist. Clearly, there is a problem here; it has been identified by the Care Quality Commission. The distressing story of the hon. Lady’s constituent that she raised with the Secretary of State in the Chamber and in the letter and again just now has been supplemented with additional stories that her colleagues have brought to the attention of the Department, and these make it clear that things need to be done in Mid Yorkshire.

What, then, is the solution to the problems that the hon. Lady has identified? The first is a local one, and all these problems have to be addressed locally, but I of course take the hon. Lady’s point that the Department has to take a degree of responsibility. Of course the Secretary of State and I take responsibility for everything that happens in the health service—that is ultimately our duty—but we cannot micromanage every hospital. It is for the local team to ensure that they are universalising the best and implementing the kinds of changes in their trust that have made such a success of hospitals not very far from the hon. Lady’s own. If they are able to do that, they will already be able to bring considerable improvements to the quality of the care that they can provide.

I can obviously do additional things as a Minister to give the local team the tools to do the job, as I can for other hospitals across the country. That includes ensuring that they have the best guidance to enable them to roster their staff properly. Lord Carter’s review is being conducted with the Care Quality Commission and with NHS Improvement. It is a tripartite review of safe staffing ratios that will give hospitals cutting-edge support to roster their staff according to the acuity of their patients to ensure maximum safety and efficiency, learning from best practice across the globe. Salford Royal Infirmary has already been looking at this particular model in one guise.

[Paula Sherriff]

My hon. Friend the Member for Batley and Spen (Jo Cox) and I share considerable concerns about the senior leadership at the trust. We have regular monthly meetings, but we were made aware only at the last meeting—we now have an interim chief executive—of some of the chaotic things that were going on at the trust, although we had been aware of anecdotal stories. We would therefore appreciate some support from the Department of Health team to ensure that communication channels between us as elected Members are as effective as possible.

[Ben Gummer]

I shall certainly impress that upon NHS Improvement, which will be taking over the functions of the NHS Trust Development Authority in the next few days. I expect that it will keep an even beadier eye on the quality of management than has been the case so far. It will do so under the watchful eye of Jim Mackey, its chief executive, who ran one of the best hospitals not only in England but in the world. He is now running NHS Improvement and I know that he will be able to provide the support that the hon. Lady wishes to see. I will tell him later this week about the discussion that we have had tonight and I will ensure that he provides hon. Members with the kind of resource that they are asking for so that they can ensure that their local leadership is doing the right thing.

On the wider issue of staffing, the fact is that the nursing numbers in the service, which were found wanting at the time of the Mid Staffs scandal, could have been addressed only by significant changes in commissioning levels not two, three or four years ago but 10, 15 or 20 years ago. The service has failed under successive Administrations to predict the number of staff that it needs for the future. One of the more extraordinary functions that I possess is to have to sign off every year the commissioning of staff that will be required in 20 or 30 years’ time. My officials are a wise and brilliant group of people, but no one can behave like Nostradamus and expect to know what the service will require after that period of time.

That is why we have come to the conclusion that we need to increase significantly the number of places commissioned. Within the current spending envelope, however, it is simply not going to be possible to achieve the numbers that we wish to see. I think that Governments from both sides would have found that very difficult—in fact, impossible. That is why we came to the conclusion that we should release those places by transferring nurse graduates on to a loan system. I know that that is unpopular with Labour Members, but I hope that they will understand the rationale behind our doing so. It will allow us to add 10,000 additional places between now and the end of this Parliament. Those are 10,000 places that we will then be able to feed into additional nursing places, which will in time solve the underlying issues that parts of the country such as the hon. Lady’s have suffered for decades.

One final aspect that I wish to bring to the hon. Lady’s attention, which I hope she will be pleased with, is that of the new role of nursing associate. It is supported by the Royal College of Nursing and to some extent by Unison, although it has reservations—a consultation is starting soon on this. It will provide a ladder of opportunity to healthcare assistants to move through an apprenticeship level up to the midway point of a nursing associate, and then on to being a full registered nurse. At present that is a course that healthcare assistants cannot take; it is not open to them.

I know that other parts of Yorkshire have no problem at all hiring healthcare assistants, but find it very difficult to hire registered nurses. That is a particular local difficulty. What I have proposed is a mechanism to give an opportunity to healthcare assistants to progress themselves, which they have many times missed out on because they did not have access to the decent formal education that we aim to provide now under the reformed education system. We are now offering, through an apprenticeship route that would not be open to them otherwise, a ladder of opportunity to a much wider group of people in the NHS, and at the same time helping to solve staffing issues where there are traditional, historical difficulties in hiring nurses.

I hope that with those general measures we will be able to do far more in the long term to solve the issue that the hon. Lady has identified. On the specific issues, I will ensure that she gets the reassurance she requires, not just on the reconfiguration, but on the leadership of her trust. I thank her and her colleague for bringing this important matter to the attention of the House.

Question put and agreed to.

Clinical Negligence Claims

Ben Gummer Excerpts

Wednesday 9th March 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

This is a fascinating matter, which deserves a great deal of debate. We could discuss this interesting subject for many hours. I am grateful to my right hon. and learned Friend the Member for Harborough (Sir Edward Garnier) for condensing a complicated issue into a 15-minute, eloquent explanation of the problems that face us.

In addition to the reading that my right hon. and learned Friend has already done, I point him in the direction of the MBRRACE-UK—Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK—report into the quality of investigations into stillbirths and neonatal injuries and deaths in the NHS, which was published at the end of last year. Although it charts a significant improvement in the reduction of stillbirths and neonatal deaths over the past 20 years due to the advancement of science, it draws one very depressing conclusion, which is that the quality of investigations has not improved since the 1990s.

I admit immediately that there is not yet any clear, scientifically proved correlation between that and the fact that litigation costs have increased, but I hope that my right hon. and learned Friend will accept my initial submission, which is that there is not the evidence for one of his claims, that somehow the increase in litigation automatically leads to an improvement in investigation and, therefore, to an improvement in patient safety. I therefore suggest that one of the statements that he made in his very careful speech is not a full reflection of the truth that we are seeking to uncover.

My right hon. and learned Friend said that we should aim to achieve proper justice and proper compensation for the claimant, and that that is the endpoint of litigation —but it is only a partial endpoint. The first thing that we are trying to achieve is an understanding of what went wrong to ensure that that is immediately transmitted back into the service, so that we prevent such a clinical catastrophe from happening to another individual or family. That is exactly where the existing system does not work, because it militates against learning early in the litigation process. In many instances, it provides a definitive account only at the point of judgment. That is what we are seeking to change through our proposed reform.

[Nick Thomas-Symonds]

I am grateful to the Minister for giving way, and I congratulate the right hon. and learned Member for Harborough (Sir Edward Garnier) on securing the debate. I also declare that I am a non-practising door tenant at Civitas Law in Cardiff.

I accept the Minister’s point about the quality of investigation. Will he also agree that access to justice is itself crucial, particularly given that the Lord Chief Justice, Lord Thomas of Cwmgiedd, recently said that access to justice is now “unaffordable to most” and available only to the very richest?

[Ben Gummer]

I will turn to access to justice. I do not entirely accept the hon. Gentleman’s interpretation of the judge’s words.

In our proposed reforms, I intend to change the balance for the NHS Litigation Authority and for claimant lawyers to ensure that we get to a single version of the truth as early in the process as possible. I accept in its entirety my right hon. and learned Friend’s interpretation of the NHSLA’s performance in past years. I do so on the basis that many claimants have been immensely frustrated—as have the clinicians involved—by the length of time that trusts and the LA have had to respond to claims, the length of time it often takes to reach a resolution and the fact that there is often too much defence, delay and prevarication. At the same time, I have full confidence in the NHSLA’s current management, because I have seen a real determination to get to grips with the problems it inherited and change the authority into something far more fit for purpose.

I accept my right hon. and learned Friend’s contention that we need to change what happens with the NHSLA, but I posit that the existing costs regime encourages some claimant lawyers to stack costs in the early stage of a claim process rather than get to what we need to do: to establish a version of the truth agreed between all parties. I am not arguing that that is a deliberate and malicious intention, but that is how the system is constructed at the moment. Therefore, in attempting to reform how costs are settled between the NHSLA and claimants, we want to incentivise learning right at the beginning of the process, to ensure that it is as rapid as possible and that, if claimants have a fair claim, they receive justice and compensation as quickly as possible. Our interests are therefore entirely aligned.

That is why I say to claimant lawyers—I have said this privately to them on several occasions—that this is a genuine consultation. We are seeking to find out how best to reform a system that we all accept is not right. I therefore warn them against peremptory lobbying of Members of Parliament about a scheme that has not yet been determined. This is a genuine consultation, in which we will accept all their views, but they cannot—I hope they will not—proceed on a basis that could lay them open to accusations of pleading for special interests rather than trying to contribute to the consultation.

[Mr McFadden]

The right hon. and learned Member for Harborough (Sir Edward Garnier) said that law firms currently reject 90% of cases brought to them because the burden of proof is high. I therefore do not think that we should portray this as a field of many frivolous claims. With that degree of rejection by law firms as background, will the Minister tell the House how the Government came to their figure for estimated savings for the new regime of £80 million? Where will those savings come from?

[Ben Gummer]

I hope that I in no way suggested that any of the claims brought forward were frivolous. I am saying that the way in which the current system is constructed loads costs at the beginning, and that does not help get us to a fair and equitable solution as quickly as possible. I am merely positing, but I believe there is fault on both sides. It is not necessarily the fault of either organisation; it is the fault of the system as a whole, which does not encourage good behaviours. The result is that we are not extracting learning as quickly as possible from litigation; we are not using claims, when unfortunately they are brought, to ensure that we improve medical practice; and, frankly, we are not using the early stage of complaints sufficiently well to ensure that claims are not brought.

I entirely agree with my right hon. and learned Friend that almost all complainants are not after a financial reward; they just want someone to say sorry and to accept responsibility for what happened. If we can achieve that far quicker in a learning culture, we will do something remarkable, not just for them, but for the many people who will follow. In answer to the right hon. Member for Wolverhampton South East (Mr McFadden), the estimate of savings proposed in the initial consultation document was part of the spending review round, and it was done through the usual modelling processes employed by the Treasury and the NHSLA, which understands the value of claims coming through.

My right hon. and learned Friend asked about the £250,000 limit. That limit was not arbitrary, but drawn from the original intentions of Lord Justice Jackson’s review on civil litigation costs in 2010, with which I know he is well acquainted. In that review, Lord Justice Jackson pressed for fixed recoverable costs in the lower reaches of the multi-track up to £250,000. That was in relation to personal injury claims, but, in trying to draw a line somewhere, we felt that that was an appropriate place, given his recommendation to do so. That is, however, subject to consultation. We want to hear the full range of views about where the limit should be placed. My right hon. and learned Friend’s contribution will be an important part of that consultation, and I and officials will take note of it.

My right hon. and learned Friend spoke of the Chinese walls and why the Department of Health is bringing forward this review. He is well aware of the usual practice that Departments bring forward proposals that relate to their areas of responsibility. The Ministry of Justice did so in previous reforms in which it had a financial interest, just as the Department of Health is doing here. I hope that, in our open approach, we will be able to explain that our primary concern is around changing the culture of the NHS and making sure that we are driving down claims for good reasons—that there are fewer of them because we are improving clinical practice—rather than just trying to deny people access to justice, which is the opposite of one of the intentions of the review.

The hon. Member for Torfaen (Nick Thomas-Symonds) is entirely right to say that we should ensure that we make justice as open as possible. The litmus test of the reform will be that, if people feel that, despite everything we are doing to make the NHS a better organisation—listening to complaints, learning from mistakes and providing restitution early—they still wish to bring forward a claim, it will be easy to do and no unreasonable barriers will be placed in their way.

[Christina Rees (Neath) (Lab)]

If a person has a claim as a result of a serious injury, but they cannot get legal representation, that person is still severely injured and the costs will still fall back on the state.

[Ben Gummer]

I am well aware of that, and that is why we need to ensure that, at the end, the reform produces good effects rather than deleterious ones. I am aware of the concerns of the hon. Lady and many hon. Members, but I ask her to be open to what the Government are trying to do and to feed in her suggestions for how we can make the system better, because clearly at the moment, as I have tried to explain, it is not working in the interests of patients in the NHS. That is why we so badly need reform of the clinical negligence system.

Finally, my right hon. and learned Friend spoke about the speech that the Secretary of State is due to give—he will brief the House in due course—and wondered whether punishment was being confused with civil law remedies. We must all understand—many in the clinical negligence community have not quite grasped this—that a revolution is going on in medicine at the moment, learning from other sectors such as air accident investigation, that appreciates that one can have learning and lessons learnt in an organisation only if one provides safety for clinicians, for example, to speak openly when something has gone wrong. Sometimes we need to provide context around such discussions to make them feel safe. That has been achieved for air accident investigations and we want to do something similar for the NHS, so the Secretary of State will make more of that plain to the House in due course.

None of that is to change the basic freedom of people to find remedies in law. As we develop this exciting area of medicine in the next few years, I hope that the interplay between those two will mean reductions in deaths, accidents and patient safety problems in the NHS by tens of thousands and then hundreds of thousands in the years to come. That will possibly be one of the biggest factors in reducing mortality in the NHS since its foundation more than half a century ago.

Question put and agreed to.

End of Life Care

Ben Gummer Excerpts

Wednesday 2nd March 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

What a fantastic debate this has been on a most important subject, with many Members bringing their personal experiences to the attention of the House, and with such agreement on both sides about what constitutes good end-of-life care and what we need to do to improve the situation.

As Members on both sides have acknowledged, the situation is already very good. As my hon. Friend the Member for Totnes (Dr Wollaston) pointed out, The Economist recently rated end-of-life care in this country the finest in the world. The hon. Member for Burnley (Julie Cooper) said that that fact made her proud to be British, and I am sure many others share that sentiment. My hon. Friends the Members for Henley (John Howell) and for Poole (Mr Syms) said that our end-of-life care was a sign of Britain at its best, not just because we are doing well compared with other countries, but because that care exemplifies many of the qualities we cherish in our communities—community work, giving and generosity, especially in our hospice movement, which is unique to this country, and of which we are proud. There is, therefore, much to be proud about.

Our end-of-life care comes from a deep tradition, which, in its current incarnation, goes back to Dame Cicely Saunders, as the hon. Member for Central Ayrshire (Dr Whitford) pointed out, but far further back too, into our medieval history. It is about care for the dying and an understanding, as many Members have pointed out, that the special time at the end of life should be cherished and that we should respect care at that time as much as we would other parts of people’s care.

However, as hon. Members also pointed out, there is much too much variation. The hon. Member for Burnley said that that in itself is something of which we should be ashamed, and I agree with her about that too. There is exceptional care in this country for people approaching the end of life, but there is also, I am afraid, care that is not good enough. Constituents have put that to hon. Members across the House, and we need to change that in this Parliament.

We need to eradicate the variation I mentioned; to quote Bevan, we need to universalise the best—that is one of the foundation stones of our NHS. Indeed, that was a promise made during the assisted dying debate. As the hon. Members for Heywood and Middleton (Liz McInnes) and for Central Ayrshire pointed out, exceptional palliative care is the foundation of all care in the NHS, and it should be the expectation of everyone reaching the end of their life. That is where I would like to start in replying to hon. Members’ remarks.

The quality of care we provide for people in hospitals and at home is a mark of how we think about the national health service and the care services we provide. We should not think of them purely as curative services; they work as curative services only if that cure is on a foundation of care, and that is why getting this issue right is so important.

My hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said this issue should be a priority, not just because of its importance in and of itself, but because it points to many of the efficiencies we can make in the health service and the care sector, which will free up money for care elsewhere in the sector.

The hon. Member for Luton North (Kelvin Hopkins) said end-of-life care embodied compassion in the service, and that is why we should place especial importance on it. My hon. Friend the Member for Poole said that respect at the end of life was something all clinicians and all others involved in care should show. Again, if we are able to achieve that for people for whom there is no cure, we can also do something remarkable for those elsewhere in the service, for whom there is, happily, the prospect of a cure.

My hon. Friend the Member for Vale of Clwyd (Dr Davies) said we needed to make particular changes in different settings, whether that was improving privacy in hospitals, improving discharge to home or improving the ability to look after people in their permanent residence, be that at home or in a care home. We need to take a range of different approaches in order to eradicate the variation that so many hon. Members have talked about. People can be expected to achieve choice only if a consistent quality of care is offered in all settings.

Hon. Members have pointed out the need to address funding, and NHS England is looking at the different currencies of care. We need also to look at the measurement of how care is provided. I have taken note of the points made by my hon. Friends the Members for Totnes and for Faversham and Mid Kent about the need to produce consistent measurements for quality of care at a local level. I hope to be able to deal with that in the not too distant future.

We need to look at the accountability of clinicians. I point Members in the direction of the “gold line” offered by Airedale NHS Foundation Trust. I take very seriously the remarks of my right hon. Friend the Member for Wokingham (John Redwood), who talked about named doctors, and refer him to the Secretary of State’s comments of 29 October where he expressly said that there should be a named consultant for patients in hospital. I hope that we will be able to extend that principle further afield, as we already have done in the course of the previous Parliament.

This matter should be addressed in a holistic manner. The hon. Member for Alyn and Deeside (Mark Tami) mentioned the need for the care of young people to be accommodated within these plans, and I intend to take that forward. We also need to consider those who are very young.

The hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Lewes (Maria Caulfield) and for Erewash (Maggie Throup) referred to people who do not have cancer, especially those suffering from Parkinson’s disease and Alzheimer’s disease, falling out of the safety net in some areas. All those points were well made and will be taken into account.

I want to reflect on the comments of many Members about the importance of having a conversation. Professionals need to be brave, as my hon. Friend the Member for Erewash said. My hon. Friend the Member for Vale of Clwyd mentioned the need for confidence from professionals and for education.

[John Redwood]

Will my hon. Friend take up my point about relatives handling the death and the lack of a medical certificate or a death certificate?

[Ben Gummer]

I will. I take my right hon. Friend’s comments on that very seriously. We are looking at the whole system of death certification, and I hope to be able to come to the House in that regard in the not too distant future. His points were very well made.

My hon. Friend the Member for Salisbury (John Glen) talked about the duty that we all have to ensure that there is a better conversation between patients and clinicians; we should all be able to have that conversation so that we can break what my hon. Friend the Member for Faversham and Mid Kent described as a taboo. At this point, not just as a Government or as Ministers but as a society, we need to grasp the nettle. We will all need to be involved so that we can give people the confidence to talk about such matters.

[Barbara Keeley]

It sounds as though the Minister is about to conclude his remarks, but he has not yet said when the Government will respond to the “Choice” review, which I asked about, as did several other Members. That is very important.

[Ben Gummer]

As I have made clear publicly, we will respond in short order to the “Choice” review, but I want to get this right. It is important that we make the content of the response as good as possible, and I do not want to compromise on that. Moreover, the hon. Lady’s party did not bring forward such a review.

This has been a very good debate on all sides. I am delighted by the cross-party support for the need to make changes. I hope that we will return to this debate in the weeks and months ahead and will be able to continue making a real change in the way that we approach death and end-of-life care in this country.

Katie Road NHS Walk-in Centre

Ben Gummer Excerpts

Wednesday 24th February 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I thank the hon. Member for Birmingham, Selly Oak (Steve McCabe) for his clear outlining of the case for his constituents and for Katie Road walk-in centre, and I congratulate him on securing this debate. He touches on an interesting issue for the NHS as a whole, one with which clinicians have been grappling in the past few years: what is the nature of urgent and emergency care in a world where demography is changing rapidly, where demands on the service are changing and where there are incredibly different and disparate populations? He rightly points out that he represents a constituency that has a high student population, that has areas with high levels of deprivation and that has a wide mix of ethnic diversity. Other parts of the country have a significantly ageing profile and do not have the ethnic mix that he is able to enjoy in his part of Birmingham; they have a different socio-economic profile.

What is clear for commissioners and for clinicians is that the answer for urgent and emergency care in one area is different from that in another. I know that might be stating the bleedingly obvious, but it was something that was not observed by the NHS before Professor Sir Bruce Keogh initiated his review of urgent and emergency care in 2013. The result of that was a holistic, sensible and coherent plan for how urgent and emergency care should be delivered across the country. The variation in care, from Northumbria down to Cornwall, is extensive at the moment; there are considerable differences. The hon. Gentleman has highlighted the fact that there are differences even within the city of Birmingham. At the very least, we have made progress in the past few years in having a vision of what urgent and emergency care should look like. The challenge is to try to implement that across the service, which is why, over the past two years, considerable work has been done by clinicians and commissioners to try to understand how the principles of the Keogh review can inform the reshaping of emergency and urgent care in their patches.

As the hon. Gentleman has identified with the issue of one walk-in centre—he can imagine how such local controversies become all the greater when they involve accident and emergency centres and trauma centres—these are matters that are very close to the hearts of constituents, who rely on those services. Those services are there in their moment of need, and they are, in a very real sense, the single greatest embodiment of the NHS and its values. We must treat urgent and emergency care with the utmost care.

The plans that are being worked up across the country are being done carefully with commissioners in co-ordination with NHS England and, ultimately, with Professor Sir Bruce Keogh. Let me give the hon. Gentleman an idea of why that has been so carefully done and the extent of care that has been taken: it was only in the autumn that the route map for the whole country was published. I hope he will therefore understand why his local CCGs have had to revise the timetables by which they have been looking at urgent and emergency care. As he pointed out, they began their own study of this in Birmingham before Professor Sir Bruce Keogh undertook his review. They have had to revise their thinking in the light of that, and I know that they are taking forward their current consultation on the basis of the route maps that have been designed by NHS England with commissioners around the country.

The hon. Gentleman makes a fair point about process. I know why he is frustrated, and I completely understand his frustration. I also understand his irritation at the bureaucratese that can fly in his face as a representative of local people. I cannot specifically talk about the consultation of which he speaks because I do not have a detailed knowledge of it. All I can say is that in the NHS there are good and bad consultations. What we have tried to do over the past five years—and I am trying to do this in my current position—is to ensure that we bring the worst consultations up to the best, that we learn from where they have gone wrong and that they go better. I can of course commit to write to the chairman of his CCG, perhaps highlighting the work that has been done around producing very good consultations, reiterating the points that he has made in his speech, and asking for a clarification around each and every point that he has raised, so that he feels satisfied that he has raised his issues in the Chamber and that he can provide answers to his constituents. Clearly, he feels that, at the moment, there is much confusion and not too much clarity.

I spoke to senior commissioners in the CCG today in advance of this debate to ensure that I was availed of the facts of the situation. They assured me that there is a full intention to continue services at Katie Road. The centre’s value is understood and well known, which is precisely why there was a temporary extension of the hours till 10 pm to deal with the winter pressures that are felt across the service. The commissioners also made it clear that there has not been a predetermination about the location of a further urgent care centre. It will be in Selly Oak, and it will be considerably larger than Katie Road so it will be able to accommodate more services and will be of greater use to the hon. Gentleman’s constituents. The commissioners have not come to a decision yet about where it should be located. I know that they will want to engage fully with him and with the community in order to ensure that it goes to the right place.

[Steve McCabe]

When the Minister was given an assurance that Katie Road would continue, he was presumably told that the contract was due to come to an end. Was there any indication that there was an intention to have yet another roll-over contract, or whether there is a timescale attached to the consultation—yet another one?

[Ben Gummer]

No, I was not assured in that level of detail—I can ask for that information in my letter to the chairman of the CCG—but I think that the intentions were clear, and they seemed entirely honourable. They understood the purpose of the centre, and they clearly saw the disadvantage of those services discontinuing before a new urgent care centre opens. I think that they understand the hon. Gentleman’s perfectly reasonable point that there needs to be some sort of continuity of service so that local people know where to go and can feel confident about local service provision.

On the important point about location and co-location, it will be different for different areas. The hon. Gentleman might have local pressures at University Hospitals Birmingham that do not pertain elsewhere in the country. It might be right—we are having exactly the same discussion in my constituency at the moment—to make use of an A&E brand and say, “Right, you have one simple place to go,” or it might be right to locate services on a different site. That will be different for different places. That is why it was decided in 2009, under the previous Labour Government, to give commissioners a greater role in local decisions on urgent and emergency care, because they are the ones who know their patches best, and what I write in Whitehall might not be right for local conditions in Selly Oak, or anywhere else for that matter.

I cannot therefore give the hon. Gentleman an answer on co-location because it will be different in different parts of the country, but what I can tell him is that my letter to the chairman of the CCG will include a particular reference to the fact that he and his constituents wish to be consulted and that there needs to be a clear rationale behind the location so that people feel that it is done not for the ease of NHS-land, but for the betterment of patient service.

The hon. Gentleman asked about consistency with seven-day services. I would like to reassure him that we are building seven-day services on the basis of the urgent and emergency care networks that were outlined by Professor Sir Bruce Keogh in his 2013 review and the consequent work. Contrary to the suggestion of his hon. Friend the Member for Birmingham, Perry Barr (Mr Mahmood), the seven-day services programme is entirely clinically led. It draws on the work that the Academy of Medical Royal Colleges undertook in 2013 to develop 10 clinical standards. That is the basis of the work we are taking forward. The contract reform that we have undertaken, both for junior doctors and for consultants, is based in part on the recommendations of those 10 clinical standards, so it is routed entirely in the need to respond to the top clinicians’ advice on how we achieve consistency of service across seven days of the week.

I would therefore expect the results of any consultation into urgent and emergency care in Birmingham to match precisely the overall work that we are doing to ensure consistency of standards across seven days of the week, good access for patients and a clear and transparent approach to urgent and emergency care, which in parts of the country, as the hon. Gentleman has identified, can at times be both patchy and confusing.

Finally, the hon. Gentleman asked whether there is a threat to walk-in centres. Under this Government he will see continued investment in urgent and emergency care. We will seek to find greater clarity around urgent and emergency care so that there is a clearer brand and more easily recognisable services for local people, so that we eliminate inconsistencies across the service and so that we fulfil the best clinical advice on how to achieve better services in urgent and emergency care by following the recommendations of Professor Sir Bruce Keogh and the work that has been done by local clinicians since. I do not believe therefore that there is a threat to urgent and emergency care services, and I believe they will improve over the next four years.

That is why I am happy to promise the hon. Gentleman that I will continue to answer questions on Katie Road. Should he have any further concerns, I would be delighted if he came to me so that we could talk about them. I will do what I can to allay those concerns and to make representations on his behalf to his clinical commissioning group so that he can get the answers he seeks.

Question put and agreed to.

Oral Answers to Questions

Ben Gummer Excerpts

Tuesday 9th February 2016 Commons Chamber

[Mr Ben Bradshaw (Exeter) (Lab)]

8. What proportion of patients exercised their right to choose where to receive hospital treatment in each of the last three years.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

The NHS choice survey, which has been carried out in its current form for the past two years, shows that the proportion of patients who said that they recalled being offered a choice of hospital or clinic for their first appointment was at 40% in 2015, up from 38% in 2014.

[Mr Bradshaw]

What the Minister just left out from his answer is that the figure was 50% when Labour left power in 2010. How does he explain this worrying fall in the proportion of patients being given a choice on the Conservatives’ watch? Will he reaffirm that choice is a legal right under the NHS constitution? Will he acknowledge that the introduction of choice by the Labour Government has been a major driver in improving NHS performance across the piece?

[Ben Gummer]

The fact the right hon. Gentleman missed out was that that was a different survey, so the figures are not comparable. However, I agree that choice is important. We are still not doing enough, and we should do more. I would like to take this opportunity to congratulate the team at his local hospital, which has just been rated good by the CQC—the first hospital in the south-west to receive that rating.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Patients needing mental health services do not get to choose where they receive their care, as highlighted in the Commission on Acute Adult Psychiatric Care report, which was published today. The report says

“the whole system has suffered from a steady attrition in funding…in recent years.”

It highlights

“poor quality of care, inadequate staffing and low morale.”

It describes the situation as “potentially dangerous”. Does the Minister now accept that the Government have let vulnerable people down? Will he implement the commission’s recommendations in full to put this serious situation right?

[Ben Gummer]

We have just received the report. It is a good report; we have taken note of it; and NHS England is already working on its recommendations. I remind the hon. Lady that this Government have put mental health on equal parity of esteem within the NHS constitution for the first time. [Interruption.] Opposition Front Benchers say that is meaningless, but why did they not do it when they were in office? We have done it for the first time and we are acting on it, not just in the constitution but in funding for the NHS, which is going up in real terms in the course of this spending review.

--- Later in debate ---

[Nusrat Ghani (Wealden) (Con)]

Midwife-led units, such as the brilliant Crowborough birthing centre in my constituency of Wealden, are key to the provision of high-quality, safe and compassionate maternity care. Last year, it scored 100% satisfaction on a friends and family survey. Will my hon. Friend outline the Government’s plans for midwife-led care, particularly given this weekend’s launch by The Sunday Times of the safer births campaign?

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Midwife-led units have increased in number in the past few years, to the great advantage of women wanting a full range of choice when they give birth. That is why we are all looking forward to the publication of the Cumberlege review, which I hope will map out the future of maternity services and show what midwife-led units will do within maternity services in the NHS. I am very excited about that, and I know that my hon. Friend will be, too.

[Alison Thewliss (Glasgow Central) (SNP)]

T7. Ministers will be aware of The Lancet series on breastfeeding and the open letter signed today by a range of organisations in the field calling for concerted action to promote, protect and support breastfeeding. Will the Minister meet me and these organisations to discuss the proposals further?

[Ben Gummer]

I am aware of The Lancet review, which makes some important points. We are not doing well enough yet in England, and it is of note that progress has been made in Scotland, Wales and Northern Ireland that we should be able to copy in England. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for public health, will want to hold such a meeting to discuss that. We have made considerable progress, but there is still a differential between rich and poor that we need to fix.

[Henry Smith (Crawley) (Con)]

I am pleased to support the National Society for the Prevention of Cruelty to Children’s “It’s Time” campaign, which is an initiative to ensure that children who have been the victims of abuse receive ongoing support. May I seek assurances from the Government that they will actively help with this initiative?

Junior Doctors’ Contract Negotiations

Ben Gummer Excerpts

Monday 8th February 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the junior doctors’ contract negotiations.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I would be delighted to update the House on the junior doctors’ proposed industrial action. The Government were elected on a mandate to provide for the NHS the resources it asked for and to make our NHS a truly seven-day service. The provision of consistent clinical standards on every day of the week demands better weekend support services, such as physiotherapy, pharmacy and diagnostic scans; better seven-day social care services, to facilitate weekend discharging; and better primary care access, to help to tackle avoidable weekend admissions.

Consistent seven-day services also demand reform of staff contracts, including those of junior doctors, to help hospitals to roster clinicians in a way that matches patient demand more evenly across every day of the week. In October 2014, the British Medical Association withdrew from talks on reforming the junior doctors’ contract and, despite the fact that the Government asked it to return, did not start talking again until the end of November last year in talks facilitated by the Advisory, Conciliation and Arbitration Service. Throughout December we made very good progress on a wide range of issues and reached agreement on the vast majority of the BMA’s concerns.

Regrettably, we did not come to an agreement on two substantive issues, including weekend pay rates. Following strike action last month, the Secretary of State appointed Sir David Dalton, one of our most respected NHS chief executives, to take negotiations forward on behalf of the NHS. Further progress has been made under Sir David’s leadership, particularly in areas relating to safety and training. However, despite agreeing at ACAS to negotiate on the issue of weekend pay rates, Sir David Dalton has advised us that the BMA has refused to discuss a negotiated solution on Saturday pay. In his letter to the Secretary of State last week, Sir David stated:

“Given that we have made such good progress over the last 3 weeks—and are very nearly there on all but the pay points—it is very disappointing that the BMA continues to refuse to negotiate on the issue of unsocial hours payment. I note that in the ACAS agreement of 30 November, both parties agreed to negotiate on the number of hours designated as plain time and I hope that the BMA will still agree to do that.”

The Government are clear that our door remains open for further discussion, and we continue to urge the BMA to return to the table. Regrettably, the BMA is instead proceeding with strike action over a 24-hour period from 8 am this Wednesday. Robust contingency planning has been taking place to try to minimise the risk of harm to the public, but I regret to inform the House that the latest estimates suggest that 2,884 operations have been cancelled.

I hope that hon. Members from both sides of the House will join me in urging the BMA to put patients first, call off its damaging strike and work with us to ensure we can offer patients consistent standards of care every day of the week.

[Heidi Alexander]

There is so much that could be said about this dispute that it is hard to know where to begin, so let me ask the Minister four simple questions.

First, the Health Secretary says that his door is open to further talks with the BMA. What does that mean? Specifically, can the Minister envisage a new contract where the definition of plain time working at weekends applies only to a Saturday morning?

Secondly, if a negotiated solution to a new junior doctor contract cannot be found, will the Minister today rule out imposing one? Does he not see how harmful imposition would be to patients, given its impact on staff morale, the risk of a protracted period of industrial action and the implications for future recruitment and retention?

Thirdly, can the Minister confirm that the pay protection offered to one in four junior doctors means that those doing the equivalent jobs in the future will be worse off? Should we not value the junior doctors of tomorrow as much as we value those of today?

Fourthly, and finally, throughout the dispute Ministers have repeatedly conflated the need to reform the junior doctor contract with their manifesto commitment to a seven-day NHS. Can the Minister name a single chief executive who has told him that the junior doctor contract is the barrier to providing high quality care 24/7? If junior doctors are the staff group who have to change their working patterns least to deliver this, which other groups of NHS staff will need to have the definition of unsocial hours changed in their contracts during this Parliament?

In the past year, the Health Secretary has implied that doctors do not work weekends, insinuated that juniors are somehow to blame for deaths among patients admitted on Saturdays and Sundays, and insulted professionals’ intelligence by telling them they have been misled by the BMA. If he was here, I would ask him whether he regrets the way he has handled this dispute, but he has not even got the nerve to turn up.

No one is saying the existing junior doctors’ contract is perfect, but if you speak to anyone in the NHS, they will tell you that this whole episode has been an exercise in using a sledgehammer to crack a nut. It is time now for the Government to do what is right for patients, for staff and for the NHS.

[Ben Gummer]

The hon. Lady wonders where to begin. I would say to her that where we begin is with the promise made to the electorate to deliver seven-day services in order to make care more consistent through the week and thereby bring down the rate of avoidable deaths. That has been the aim of this Government—pursued in the guise of the previous coalition and by the current Government—for some years. The junior doctors’ contract, about which negotiations have been going on for some years, has been framed partly in that respect during that time.

The hon. Lady asks a number of questions, and I will answer them directly. She asks whether the door is open and whether the Secretary of State is willing to see further talks. Of course it remains open. Throughout the entire process—from back in the summer, when the BMA made it a point of principle not to return to talks—we have asked the BMA to come back to the negotiating table time and again. I have done so, as has the Secretary of State, so the door remains open. I hope that, in the coming days up to the strike, such contacts will continue.

The hon. Lady asks whether there can be discussions about Saturdays. The Secretary of State has made it plain throughout the process that every aspect of the contract is open for discussion. What is not up for discussion is the ability of hospitals to roster clinicians on a consistent basis through the week. The one group of people who are refusing to negotiate about Saturdays or anything to do with the extension of plain time is the British Medical Association. Despite its assurance—in fact, its promise—at ACAS at the end of the November that it wished to discuss this issue, it has now refused to do precisely that with Sir David Dalton. We are therefore left at an impasse, where I am afraid that on the one item left to discuss, which is Saturdays, it is refusing point blank to open a discussion because of what it calls an issue of principle. For us, the principle is patient safety, and that is why we will not move.

The hon. Lady’s second question was about the introduction of a new contract. At some point, the Government will need to make a decision. Time and again, we have extended the point at which we will introduce the new contract, precisely so that we can give time for talks to proceed, even though the BMA, in a disjointed manner, refused to discuss it for several years until this point. At some point, we will have to make the changes necessary to get consistency of service over weekends. We cannot delay this any longer. No Health Secretary or Health Minister could stand in the face of the many academic studies that have shown there is an avoidable weekend effect and say that nothing should happen. Of course this should be done in concert with other contract changes—changing the availability of diagnostics, pharmacy and other services—and we have always said that it is part of the piece, but it has to be done at some point and that point is fast approaching.

The hon. Lady asks whether imposition will be harmful to patients. I ask her to consider whether avoiding changing rostering patterns to eliminate the weekend effect would not itself be harmful to patients to the number of several thousand a year.

The hon. Lady asks about pay protection. We have urged the BMA to put to its members the pay protection that we made clear right at the beginning of the process, but I am afraid that it wilfully misled its members about the pay offer that we put on the table. I ask her, therefore, to be careful in what she says. For this cohort of junior doctors, this is a very good deal. Those who are coming into the service can be assured that they will have a quality of contract that the current cohort has not benefited from: a reduction in the maximum number of consecutive nights from seven to four; a reduction in the maximum number of consecutive long day shifts from seven to five; a reduction in the maximum number of consecutive long late shifts from 12 to five; and a reduction in the maximum number of hours one can work in a week from 91 to 72. Those are considerable improvements in the contract that will protect the safety and working practices of future generations of junior doctors.

When the hon. Lady wrapped up her remarks, she asked whether we had any regrets about the way this process has proceeded. We do have regrets. We regret that the BMA wilfully misled its members at the beginning of the process, making them believe that there was going to be a cut to pay and an increase in hours, neither of which was true. We certainly regret the fact that the BMA refused to talk to us for months on end, when many of these issues could have been dealt with. We certainly regret the fact that the BMA has gone back on its promise to discuss plain time hours—a promise made at ACAS that it has now reneged upon. I am afraid that in dealing with the BMA, we have not been able to address the matter that is most important to doctors, which is protecting patient safety. That is why, in the end, we will have to come to a decision on this contract for the betterment of patients and the consistency of clinical standards through the week.

[Dr Sarah Wollaston (Totnes) (Con)]

Under the current contract, too many junior doctors are forced to work excessive hours and are overstretched during the hours they work. Will the Minister, having set out that the hours will be reduced, reassure the House about what measures will be put in place to make sure that managers do not let this slip and that we do not return to the days of overworked junior doctors?

[Ben Gummer]

My hon. Friend is right that new measures have been introduced in the proposed contract. A new guardian role, which was proposed by NHS Employers, will help to protect the hours of junior doctors in individual trusts. That has been a point of success in the negotiation between the BMA and NHS Employers. A new fines system, which is not currently in place, will penalise trusts and ensure that the moneys that are generated by the fines go towards enhancing the general wellbeing and training of doctors within those trusts.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Obviously, I am disappointed that it is not the Secretary of State we are speaking to today. The Minister referred again to weekend deaths. I gently point out that if one studies the evidence from Freemantle, one sees that there is a lower level of deaths at weekends. Perhaps we might be a bit more precise and say that we are talking about people admitted at weekends who die within the next 30 days.

I welcome the commitment to increase diagnostics and social care, as I think will everyone in the NHS, but junior doctors already work seven days and seven nights a week, so I really do not see how they can be the barrier to the safety of patients.

I do think that, on looking back, the Secretary of State and the Minister may regret how this matter has been handled. Right from last summer, it has been so combative. In October, when we debated the junior doctors, the Secretary of State was still refusing to go to ACAS, so this cannot all be put on the BMA. Doctors are not stupid; they are capable of reading what has been offered. Many of the junior doctors who have written to me have talked about the fear of hours getting out of control. When I was a junior doctor, the hours were ridiculous and it was the automatic financial penalty on trusts that changed things. It is important that their concerns are listened to and that they are not patronised, as they were on the Marr show yesterday. That has aggravated things further, and the way in which this process has been dealt with from beginning to end has been really disappointing.

We are facing the second day of strike for the first time in 40 years—that is my entire career. What does the Minister feel will be brought to the table by the Department of Health in the next few days to try to get out of this and to try a different approach? We do not have junior doctors on the streets in Scotland. He has to ask himself why we have them on the streets here.

[Ben Gummer]

The hon. Lady speaks from experience, and rightly points to the fact that avoidable mortality that is attributable to weekends is different from mortality at weekends—the Secretary of State has been clear about that in his public statements. However that gap does exist, as the hon. Lady knows, and Professor Sir Bruce Keogh was clear in his statements that there is an avoidable rate of mortality. He stated:

“There is an avoidable ‘weekend effect’ which if addressed could save lives. This is something that we as clinicians should collectively seek to solve. It also strengthens the moral and professional case for concerted action.”

The way in which the hon. Lady characterised the discussions in September, October and November is not quite right. We implored the BMA to come and talk; I personally had those discussions with leaders of the BMA, and they refused to do so. It was only when they came and talked to us that we made substantive progress.

The hon. Lady is right to raise these issues, and we wanted to discuss such matters with the BMA. One issue was protection against excess hours, but we had no counterparty with whom to negotiate. Since we have had that counterparty, we have made good moments of progress, and the result is the guardian position, which she welcomed in another place. The guardian will be able to levy fines, and those fines will be remitted to the guardian. I hope—and indeed expect—that process to reduce the excess hours that we still see in a small minority of positions. We must get away from the perverse incentives for trusts and a small minority of doctors that mean that unsafe working hours are perpetuated.

Of course we all regret the course that this dispute has taken, but it would not have done so had the BMA taken a responsible position from the beginning. If people lie to their members and say that they will have their pay cut and their hours raised, of course doctors will be angry—all of us would be. The fact is that that was never true, but it has inflamed the situation. We could have had the kind of productive talks that we have had over the past three or four weeks back in August, September and October had we not had all the mess beforehand because of untruthful statements issued by the BMA.

[Helen Whately (Faversham and Mid Kent) (Con)]

The level of support among junior doctors for this pay dispute is at least in part because of longstanding dissatisfaction with the experience of being a junior doctor. Sir David Dalton recommended a review of those longstanding concerns in his recent letter. Do the Government intend to commission such a review?

[Ben Gummer]

The Government will be looking at Sir David Dalton’s recommendation and acting on it. He is right to point to the fact that the 1999 contract is imperfect—it was agreed back in 2008 that it had many failings, and that something needed to be done to fix it. That contract in its generality has helped to contribute to the lowering of morale in the junior doctor workforce, which Sir David Dalton has recognised, as has the Secretary of State. It is not just the way in which training placements are made and a whole series of other problems with the contract; it is also the fact that people have to work for long periods of consecutive nights and days, all of which is reduced in the latest proposed contract.

[Mr Dennis Skinner (Bolsover) (Lab)]

Is the Minister aware that it takes two sides to call a strike? It cannot happen just because one side of the argument wants a strike. The Secretary of State has been looking for a fight with the doctors ever since he got the job. Does he realise that when I came here 45 years ago, I was getting time and a half for all-day Saturday, and double time, like other miners, for Sunday? Every time the doctors are replaced by agency nurses it costs the Government and the taxpayer a small fortune. Get the matter settled, and be decent for a change.

[Ben Gummer]

The hon. Gentleman has long prized himself as a champion of working people, yet the current contract and the proposed contract by the BMA, which I presume the hon. Member for Central Ayrshire (Dr Whitford) supports, prefers junior doctors over porters, cleaners and junior nurses, and it gives them better rates of pay, and premium rates that could not be enjoyed by lesser paid workers under contracts negotiated by unions that the hon. Gentleman supports. Here we have it: the final morphing of the Labour party into a party that prefers professionals over porters. That, I am afraid, is the party that he is now a member of.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I very much support the Government’s stance on junior doctors, while acknowledging that most doctors—junior and senior—work well beyond their contracted hours. Does the Minister agree that it is not junior doctors but their seniors, and seniors’ terms and conditions, who really set the tempo in our national health service?

[Ben Gummer]

My hon. Friend also speaks from experience. We have said right from the beginning that reform of consultants’ and junior doctors’ contracts will be critical in delivering seven-day services. On consultants’ contracts, it is important to make sure that consultants are providing clinical cover over weekends, not just for the benefit of patients but for juniors, who are often covering rotas without clinical cover from consultants with and to whom they might wish to confer and refer.

[Mr Ben Bradshaw (Exeter) (Lab)]

Is it not at the very least odd that the Secretary of State yet again chooses to stay away and not come before the House to answer questions on this very important subject? As a former Health Minister, I know how difficult the BMA can be, but this would seem to indicate to me that it is the Secretary of State who has become the main obstacle to a sensible solution to this crisis.

[Ben Gummer]

The right hon. Gentleman will know that, numerically, the previous Labour Government had far more scraps with the BMA than the coalition Government and this Government have achieved so far. He will know that it is a mark of all Health Secretaries to have disputes of one kind or another with the BMA. The Secretary of State will be here tomorrow, since the right hon. Gentleman asks, to answer oral Health questions.

--- Later in debate ---

[Crispin Blunt (Reigate) (Con)]

I wonder whether the Minister can help me. The messaging I have heard from the BMA is that the dispute is nothing to do with pay. We have heard the issue described as a “nut” by the shadow Secretary of State, yet it has led to a national strike for the first time in 40 years and we face industrial action again. What is going on here?

[Ben Gummer]

That is a question I am increasingly asking of those in the BMA’s leadership. They have agreed with Sir David Dalton that the remaining issue is about pay. Having said for several months that it was not about pay, they have now, in the end, come clean and said that it is about pay. That is what we are dealing with: pay rates for plain time and for Saturdays, where they wish for preferred rates over nurses and other “Agenda for Change” staff.

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

Junior doctors in my constituency are only very reluctantly taking action on Wednesday. They are supported by many of my constituents, who think that it is simply a disgrace that junior doctors are being forced to take industrial action because the Government are simply failing to address the legitimate concerns raised by the BMA. I heard the Minister say that his door is open, but what he is actually going to do to settle the dispute, and does he think it helps to denigrate the BMA in the Chamber this afternoon?

[Ben Gummer]

The hon. Lady says the junior doctors in her constituency had legitimate concerns. They did. Every single one has now been answered in the negotiations between Sir David Dalton and his predecessors apart from one, and that is the one the BMA refuses to open negotiations on, despite having promised to do so in November last year. Yes, our door remains open, but the BMA has first to agree to talk to us, which it is again refusing to do.

[Alex Chalk (Cheltenham) (Con)]

Junior doctors in Cheltenham are some of the most dedicated and hard-working people anywhere in our local community. It is therefore a concern to me that some have cited information from the BMA suggesting that the Government are proposing a pay cut. Will the Minister make the position crystal clear? Is that right?

[Ben Gummer]

No, it is not.

[Norman Lamb (North Norfolk) (LD)]

Does the Minister ever wonder whether he has chosen the wrong target? He bases his entire argument on safety—and rightly so—yet chairs and chief executives of hospitals constantly tell me that they have no difficulty staffing their hospitals with junior doctors over weekends. At the same time, however, our GP out-of-hours services are under incredible strain and cover is threadbare in many parts of the country. That, surely, is where the real safety concerns lie.

--- Later in debate ---

[Ben Gummer]

The right hon. Gentleman will know that we are looking at the contracts for GPs, consultants and junior doctors: they are of a piece. We cannot see one clinical group in isolation, when they work together. He should know, therefore, that in concluding discussions with junior doctors, consultants and GPs, we need to ensure that we give hospitals and primary care settings the ability to roster staff consistently through seven days of the week.

[Maria Caulfield (Lewes) (Con)]

I have met junior doctor colleagues over the last few weeks and months, and I know that many of them are cautious about the new contract and that strike action is the absolute last resort for them that they would rather not take. I met one of my constituents from Polegate this morning whose operation is going to be cancelled this week, thanks to the strike action. I welcome the Minister’s comment that the door is still open even at this late hour to call off the strike. Would he find it helpful if the shadow Secretary of State also condemned the strike and asked the doctors to call it off, so that patients do not become the real losers in this dispute?

[Ben Gummer]

My hon. Friend points to an interesting fact—that despite these many months of discussions, we have never had a clear line from the shadow Secretary of State or from the Opposition generally on whether they condemn or support the industrial action. It would be helpful if they made that clear because we would know at least whose side they are on. Are they on the side of patients, where we are trying to eliminate the weekend effect, or are they on the side of the BMA’s leadership?

[Angela Rayner (Ashton-under-Lyne) (Lab)]

I find the Minister’s language and tone in regard to the BMA and the junior doctors unfortunate. He speaks as though junior doctors do not care and do not want to help their patients, and I find that regrettable. In my time as a Unison official, when I used to represent public sector workers in health care, the BMA was hardly known for its militancy within that organisation, and the Minister needs to reflect on that. Does he really think that this whole problem is, as my hon. Friend the Member for Bolsover (Mr Skinner) denied earlier, all the blame of the BMA and doctors? Doctors care about their patients; that is why they are in this position. Does the Minister not accept any responsibility for the impact?

[Ben Gummer]

I entirely agree with the hon. Lady about the passion and dedication of junior doctors—and never once has the Secretary of State or I questioned that. What we have questioned are the tactics of the BMA’s leadership. I happen to agree with her, too, about her previous employer Unison. I have constructive relationships with that union. I disagree with it, and it with me—often—but we agree on many things and have a straightforward relationship. I am afraid that it is difficult to do business with the BMA, however, when it promises to talk about one thing and then refuses to do so a few weeks later, when it refuses to come to the negotiating table for months, and when it misleads its members in a way that I do not think Unison has ever done.

[Maggie Throup (Erewash) (Con)]

The residents in my constituency tell me two things: first, how much they value the work of doctors, both junior doctors and consultants; and, secondly, how disappointed they are that this House is not united in saying that the strike is not justified on safety grounds. Is the Minister as disappointed as my residents?

[Ben Gummer]

Yes, and I would add the 2,800 people who have had their operations cancelled. I wonder what answer they would get from the Opposition about whether they support or condemn those cancellations. As soon as we get an answer to that very simple question, it will be easier for us to know the official position of Her Majesty’s Opposition.

[Julie Cooper (Burnley) (Lab)]

Yesterday, the Secretary of State for Health accused the BMA of misleading junior doctors. Today, the Minister comes to the House and accuses the BMA of lying. Is he really asking us to believe that some of the most intelligent people in the country—junior doctors—cannot see for themselves what the Government are proposing? Does he not feel that the continued abuse directed at the junior doctors’ representatives is hindering any possibility of a settlement to this dispute and that that is damaging to patients?

[Ben Gummer]

The hon. Lady is also an intelligent woman, so let me ask her this. If a trusted body, such as the BMA, tells its members that they will have a pay cut of 30% and an increase in hours, but that statement is incorrect, does it constitute a lie? That is the question I would put back to her.

[Stuart Andrew (Pudsey) (Con)]

A number of Members met representatives of the BMA in the House of Commons. We were disappointed that, despite continued questioning, they refused to go to the negotiating table, but thankfully they eventually did so, and made some progress. My constituents want a safe, seven-days-a week NHS. Is it not time to get back around the table, so that we can provide the service that NHS patients want?

[Ben Gummer]

It is, and that is why we need to move ahead in fairly short order. Ultimately, if staff contracts are not reformed across the service, those who will suffer most will be patients, and what will be most affected is the consistency of care that they receive at weekends.

[Margaret Greenwood (Wirral West) (Lab)]

The shadow Health Secretary asked the Minister if he could list the hospitals in which there were currently not enough junior doctors working at weekends. He could not answer that question, so I will give the Minister another chance. Will he name them for us now?

[Ben Gummer]

Evidence given to the Review Body on Doctors and Dentists Remuneration made clear that rostering was made more difficult by the current plain-time terms in the contract. That is why it has been on the table for several years and has been the subject of parts of our discussions with the BMA, when we have been able to have them. It is also why one of the leading chief executives in the country, Sir David Dalton, who led the latest round of talks, has pressed the BMA to come and talk about Saturdays specifically and plain time in general. The BMA has refused to speak about either.

[Richard Drax (South Dorset) (Con)]

Whatever the arguments in this case, I can think of no one more honourable, decent and honest to run the negotiations than my right hon. Friend the Secretary of State. It is reported that graduating medical students applying to be foundation year 1 and 2 junior hospital doctors are seeking work in Northern Ireland, Scotland and Wales to avoid the new contract. Is that true, and if it is, what can be done to stop this drain of our best medical students?

[Ben Gummer]

We do not see any particular evidence of the movement of juniors at present, but what we would most like to see for juniors is the introduction of the new contract, so that they can recognise that it will be better for their working practices than the current one. It is in everyone’s interests—not just those of juniors, but those of patients—to ensure that juniors work safe hours. That is why the new contract involves reductions in the number of consecutive nights and long days, and it is why we want to reduce, and eventually eliminate, the excessively long hours in the week.

[Christian Matheson (City of Chester) (Lab)]

I am sure that Ministers have a very clear idea of how their proposals will affect working practices, so may I ask this Minister on how many occasions last year a junior doctor worked 91 or more hours in a week?

[Ben Gummer]

We believe that last year about 500 junior doctors were operating on a band 3 payment, which equates to payments for hours of work that exceed what is specified in the working time regulations. That is a relatively small number within the NHS, but it is still significant, and for the doctors concerned, working those excessive hours is unsafe.

[Mark Spencer (Sherwood) (Con)]

Will the Minister join me in thanking the junior doctors who ignored the call to strike last time, and does he agree that the lack of condemnation from the Opposition demonstrates that they are putting their support for industrial action before my constituents and their healthcare needs?

[Ben Gummer]

I entirely agree. Rather like an arsonist who pours petrol on a fire and then runs to offer help to put it out, the Opposition have done very little to help to get the contract into the place where it needs to be, and to stop the industrial action. I am afraid that the patients whose operations will be cancelled this week will suffer partly because of the Opposition’s failure to take a firm stand.

[Fiona Mactaggart (Slough) (Lab)]

As the Minister will know, Wexham hospital in Slough has enormously improved the care that it gives to its patients. It has done that with the same staff, but with a leadership which says to the people who work there that it has confidence in them and shares their values. The Minister is saying that he is the only person who cares about patient safety, and that doctors do not. What does that do for morale and for doctors’ ability to improve the quality of care for patients?

[Ben Gummer]

I am not sure how to answer the right hon. Lady’s question, given that she has wilfully misconstrued what I said. I have never once suggested that only the Government care about patient safety. Almost every doctor out there cares for nothing other than patient safety and patient care. However, according to the 10 clinical standards of the Academy of Medical Royal Colleges, if there are to be consistent levels of care over the weekends, part of that will be achieved through reform of staff contracts. One of those is the junior doctors’ contract, which is why we must press ahead with it.

[Wendy Morton (Aldridge-Brownhills) (Con)]

I commend my hon. Friend for all the work he is doing to deliver a truly seven-day-a-week health service for the benefit of not only my constituents but those of every other Member. I am a little surprised by the hon. Member for Lewisham East (Heidi Alexander) saying that no one thinks the existing contract is perfect. Does the Minister agree that we should all be working together in the interests of our constituents to bring this situation to a successful conclusion, rather than trying to score party political points with it?

[Ben Gummer]

I agree with my hon. Friend. I am afraid that this is a mark of the way in which the Labour party has changed. I suspect that a Labour party of a different era—one that was more responsible in how it dealt with industrial disputes—would have understood on whose side it should be acting at this point.

[Nic Dakin (Scunthorpe) (Lab)]

This is a Conservative Government, but to have a strike of this kind on any Government’s watch is a disgrace and a failure. I quite like the Minister actually, but he has only ever laid the blame for this elsewhere. Surely, the Government should be evaluating their own performance and saying, “We can do better than this and we should ensure that this does not happen,” even at the eleventh hour.

[Ben Gummer]

The hon. Gentleman tempts me with kindness, and I repay the compliment. However, having been involved in this process for some months now, I have found it incredibly frustrating. Up to the end of November, every time we asked the BMA to come and talk to us, it refused, despite personal entreaties. And when it did talk to us, we often found that we had nailed down an agreement only to find it slipping out of our fingers the next day in front of the media. This has been a hugely frustrating and difficult process for everyone concerned—not only for us but for the junior doctors, who have been left confounded and confused by the whole thing.

[Dr Tania Mathias (Twickenham) (Con)]

Does the Minister agree that most, if not all, junior doctors exceed their contracted hours and that a 72-hour limit is therefore essential? Will he also acknowledge that, even after the negotiations are complete, many junior doctors will continue to exceed their contracted hours?

[Ben Gummer]

Some junior doctors exceed their contractual hours. The average across the service is 48 hours, but some are working as many as 91, which is the current permitted limit outside the working time directive. We wish to stop that altogether and bring it down to an absolute maximum of 72 hours a week, which would equate to a 48-hour average over the agreed period, which is currently six months. The key is to get the number of hours down, because working excessive hours is unsafe for patients and for doctors.

[Barry Gardiner (Brent North) (Lab)]

The Minister has been keen to establish what he sees as the preferential terms and conditions that junior doctors enjoy, yet Sir David Dalton has said in an interview with the Health Service Journal:

“My assessment is that the staff group that will have to contribute the least above that which they are providing at the moment would be our doctors in training. Our messaging on this has got muddled”.

Does the Minister agree?

[Ben Gummer]

Sir David Dalton has also made it clear that we have to reform all contracts. One can place the balance where one wishes, but it is important that we reform the juniors’ and the consultants’ contracts together, so that they can fit within the service of a piece. It is wrong, for instance, to have a junior on duty taking decisions at the weekend and not be covered by consultants supervising and helping with those decisions. We need to ensure that there is consistency of rostering through the week and at the weekend involving both juniors and seniors.

[Robert Jenrick (Newark) (Con)]

I represent many junior doctors. I have met them and I have tried to represent their views to the Government, but I have always taken the view that my primary responsibility is to the patients of the NHS. One of those patients, a constituent of mine, emailed me this week to say that a consequence of the strike would be the

“cancellation of my wife’s biopsy, planned for this week, without which her already shortened life will be shorter”.

Will the Minister, the shadow Minister and the whole House join me in condemning this strike? It will achieve nothing. It is a distraction from the negotiations, which need to continue, and it will put the lives of my constituent and others across the country at risk.

[Ben Gummer]

I cannot possibly add to the comment made by my hon. Friend, and I just hope the shadow Secretary of State takes note.

[Liz McInnes (Heywood and Middleton) (Lab)]

Strike action is always a last resort, and I can say categorically, as an ex-NHS worker, that no NHS worker wants to go on strike. We have here a complete failure of negotiation. The Secretary of State’s door may be open, but the inflammatory and insulting comments he made in the media this weekend do not exactly invite people to cross that threshold and talk to him. Given that he has manifestly failed as a negotiator, is it not about time he stood aside and let a trained negotiator deal with the BMA and come to an agreement, before it is too late?

[Ben Gummer]

I am not sure the hon. Lady has been listening to the statements made in this House and elsewhere.

[Liz McInnes]

I have been listening—

[Ben Gummer]

I am not sure the hon. Lady has been listening because otherwise she would have heard that the negotiations have already been taken on by leading negotiators from NHS Employers and, latterly, by Sir David Dalton, one of the leading chief executives in the country. Significant progress has been made, contrary to what she has just suggested. Negotiations have worked. We have managed to nail down—[Interruption.] The hon. Lady shakes her head, but the fact is that Sir David Dalton has managed to secure agreement on every single point of contention other than pay rates for plain time, unsocial hours and Saturdays. This dispute on Saturday and the kind of results we are going to see across the country on Wednesday will, in essence, be about pay rates on a Saturday, with the BMA wanting preferential rates over nurses, porters, cleaners and other workers in the NHS.

[Ben Howlett (Bath) (Con)]

May I join colleagues in thanking the Minister and the Secretary of State for all their work in negotiating a contract, which is obviously a tough discussion to have? Although many of my constituents may have sympathised last year with the BMA’s case, patients and their families, including my father after a recent heart valve replacement, will be concerned that the BMA is not getting around the negotiating table and thus placing a lot of undue stress on the most vulnerable. Does the Minister agree that the BMA should seriously consider those patients as it protracts its negotiations?

[Ben Gummer]

If the BMA was truly representing its members, it would be thinking about patient welfare during the strikes. Just now, we heard my colleagues describe with great eloquence the kinds of effects on individuals that a strike will cause. These strikes will get us no nearer to a solution; the only way to come to a solution is by negotiation.

[Matt Warman (Boston and Skegness) (Con)]

It is testament to the progress being made in the course of these negotiations that the BMA has cancelled some strikes and has downgraded the one we are expecting on Wednesday, but does the Minister agree that one crucial thing that would make the greater difference would be condemnation from the Opposition?

[Ben Gummer]

It would make a significant difference. Now that the Leader of Her Majesty’s Opposition is sitting on the Front Bench, he might like to take note of the fact that if we have a united political response condemning strikes that affect patients and their safety, it helps to bring negotiations to a more profitable end.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Hull royal infirmary is under a black alert, which means that local people have been told not to attend the hospital unless it is a matter of life and death. Will the Minister tell me how the insults the Secretary of State has been throwing around over the weekend, and those that he himself has made today about hard-working and dedicated junior doctors, will help people in Hull, who need a functioning NHS? How will those insults improve the morale of those doctors?

[Ben Gummer]

The hon. Lady does dangerous work if she tries to conflate the comments that I and others have made about the leadership of the BMA with the motivations of junior doctors, none of whom I have impugned. I recognise that junior doctors work incredibly hard, care passionately about their patients and have a vocational drive to do the best for the people they care for, but that is different from an organisation that refuses to talk, refuses to negotiate, lies to its members and is very slippery in the statements it puts out to the press.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital is always under huge pressure, and the junior doctors there do a fantastic job. May I tell the Minister that my constituents will be extremely disturbed to hear him tell the House today that the BMA said at the ACAS talks that it would negotiate about Saturday pay but is now refusing to do so? The consequence will be a strike on Wednesday, and my constituents are appalled that 2,884 operations have already been cancelled, with that number possibly set to go even higher.

[Ben Gummer]

My hon. Friend is right about that. He mentions one of a number of agreements that we have come to with the BMA in the course of these discussions that have subsequently been reneged upon by that organisation. That is why this whole process has been so torturous for everyone involved.

Huddersfield Royal Infirmary

Ben Gummer Excerpts

Tuesday 2nd February 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to serve under your chairmanship, Mr Pritchard. I, too, thank my hon. Friend the Member for Colne Valley (Jason McCartney) for the clear-sighted way in which he set out his case. This clearly is a cross-party effort, for which I respect him all the more. Everyone sitting in this room has come here with earnest intent on behalf of their constituents, and I take their representations very seriously indeed. I appreciate the comments of those who have spoken in this debate, including the hon. Members for Batley and Spen (Jo Cox), for Huddersfield (Mr Sheerman) and for Dewsbury (Paula Sherriff). I also thank the shadow Minister. There was an intervention from the hon. Member for Strangford (Jim Shannon), who has left.

This is one of what I imagine will be a series of debates on reconfigurations, because throughout the NHS’s history—I am sure the hon. Member for Huddersfield will know this better than me—reconfigurations and the configuration of health services has been a feature of how the NHS works. In beginning to respond to the debate, it would be helpful if I set out where the Secretary of State and I stand in relation to reconfigurations. That will explain what I am able to do and, perhaps more helpfully, what I am not able to do, because that has changed in the past few years.

I recognise that the clinical commissioning group has presented a very detailed plan—the plan is very detailed, whatever one’s arguments about its merits, or otherwise—but it has, rather classically, chosen a title, “Right Care, Right Time, Right Place,” that is so generic in its quality and so indirect in its aspiration that the CCG should first look to change the title to say what it actually proposes to do. Such generic consultation titles and bureaucratic-speak are a feature across the NHS, and it does not help anyone to get to the nub of the matter.

Were the reconfiguration to procced, it would be for the CCG to make the decision about how it wished to buy services on behalf of the people it serves. That is a key reform of the Health and Social Care Act 2012 but, even before then, previous Secretaries of State—Labour ones—recognised that it is wrong for Whitehall to make determinations on matters of reconfiguration because it is often influenced by politics when it should be the clinical voice that is heard first and foremost.

The hon. Gentleman mentioned the former Prime Minister Harold Wilson a number of times. Harold Wilson was a well-known exponent of valuing expert opinion, and we should do that in the NHS above all, because we are dealing with people’s lives. That is why I ask people speaking in this debate more broadly to listen carefully to what clinicians are saying on both sides of the argument and to weigh up their opinions before coming to a settled point of view.

[Mr Sheerman]

I absolutely agree with the Minister. It is the clinicians who are talking to us. The clinicians in hospitals do not want this reconfiguration and do not agree with it; it is general practitioners jumped up into management in the CCG who are putting this before us. The clinicians to whom my colleagues and I have talked are almost uniformly against the reconfiguration. He is absolutely right. If we listen to the clinicians, we will have A&E in both hospitals.

[Ben Gummer]

I will come on to that process. It is a little unfair to characterise the clinical commissioning group in that way. Primary care is the frontline of all patient care in this country. GPs see and deal with the majority of patients in the health service, and they guide the patient pathway. Therefore they should have responsibility for ensuring that services are fit and proper for patients. It is GPs who make the decision on how that happens. If local people disagree with that decision, as the hon. Members for Dewsbury and for Batley and Spen are experiencing in their own areas, a referral can be made to the Independent Reconfiguration Panel via the local authority’s overview and scrutiny panel. The Secretary of State will then take the recommendations of the independent panel.

So far, out of a number of Secretaries of State, none has chosen to go against the panel’s recommendations, although there is always a first time. However, the panel exists, and I do not think that anyone disputes its independence. That is the process. All that I can do here is set out the broader clinical arguments on which I know the CCG will draw, and with which I expect all Members will agree, to talk about private finance initiatives and answer the specific questions raised by speakers in this debate.

For the record, I will explain what the CCG claims are its reasons for the reconfiguration. It is important for people watching this debate to know the CCG’s side of the story also. The CCG believes that the NHS services in Halifax and Huddersfield, as currently organised, do not deliver the safest and most effective and efficient support to meet patients’ needs. It believes that the trust is affected by shortages of middle-grade doctors and a high use of locums in its accident and emergency department; I will turn in a minute to the remarks on that matter by the hon. Member for Huddersfield. Sickness absence levels are high, and clinical rotas are described as “fragile”. There are difficulties providing senior consultant cover overnight and seven days a week, which is a wider issue in which hon. Members will know the Government have an interest.

Both hospital sites operate an emergency department and a critical care unit. The care provided by both those services is, in the CCGs’ view, neither compliant with some of the standards for children and young people in emergency care settings nor fully compliant with guidance on critical care workforce standards. Neither site satisfies the Royal College recommended minimum of 10 consultants per emergency department and 14 hours a day of consultant cover.

Inter-hospital transfers are often necessary due to the lack of co-location of services on both sites. Those factors have a direct bearing on the safety of patient care. The co-location of emergency and acute medical and surgical expertise can result in significant improvements in survival and recovery outcomes, most notably for stroke and cardiac patients. The most seriously ill with life-threatening conditions have a much greater chance of survival if they are treated by an experienced medical team available 24/7. That last comment is not just the opinion of the CCG; it is the recommendation of Professor Bruce Keogh, the medical director of NHS England. I think that we all agree on the principles from which he speaks.

The CCG believes, first and foremost, that the proposals are designed to save lives. It is not an issue of cost. However, there is an issue of cost involved in deciding where the co-located services should go. We must be open about that; the CCG has made a value for money determination suggesting that the better site is in Halifax, at Calderdale Royal hospital, and not at Huddersfield.

[Mr Sheerman]

On finance?

[Ben Gummer]

On a value for money basis, because of the ability to release the Huddersfield site to build the new hospital and the more modern facilities available in Calderdale. That is the CCG’s determination, and it is important in these discussions that everyone examines whether they believe that the CCG has made the right determination.

Turning quickly to an issue of numbers, I want to make a general point about the number of people being supported by A and E services across the country. The current chief executive of NHS Improvement, Jim Mackey, ran a successful large hospital system in Northumberland where a reconfiguration is providing some of the finest patient outcomes not just in the United Kingdom but in western Europe. It was brave and controversial at the time. What he has proved, and what has subsequently been proved in Manchester and in London stroke services, is that where services are reconfigured sensibly, outcomes improve. I know that that is the driving ambition of clinicians in Mid Yorkshire, and indeed in Huddersfield and Halifax. Whether they are arriving at the correct way of delivering those improved outcomes should be the exercise of the consultation, so it is an appropriate way to start the debate, but it is important to inform the discussion with all the current facts.

According to Public Health England, the Calderdale and Huddersfield NHS Foundation Trust serves a population of 402,000 across two hospital sites. That means that each hospital serves what is, in the scale of the NHS, a small population group. To give some local comparisons, Leeds Teaching Hospitals Trust serves a population of 752,000, and Mid Yorkshire Hospitals NHS Trust is also a bit larger at 553,000. Within the scale of local health economies, Calderdale and Huddersfield serves a relatively small population, across two sites. The CCG’s judgment, and I suspect clinical opinion across the NHS, is that something must be done to improve clinical outcomes by concentrating consultant and clinical offer. I am not making any judgment about where that should happen, merely about the principle being established by senior clinicians.

Turning to the issue of deaths, it is the judgment of Professor Bruce Keogh, who is coming to the end of his urgent and emergency care review, that intensive procedures are best done by people who are well practiced and do many a year. The best way to do so is to ensure that they are concentrated in centres of excellence. The understanding of the rest of the world is that we prevent deaths by doing so. The hon. Member for Huddersfield contends that we could cause 157 deaths by joining the services.

[Mr Sheerman]

In Halifax.

[Ben Gummer]

Yes. I caution the hon. Gentleman about using such figures. Whereas the CCG has been careful not to use a precise figure for how many lives will be saved, merely citing international evidence about improved outcomes, that figure, which has been provided to him, makes the serious error of conflating and confusing emergency admissions with emergency attendances; they are two completely different things. Using those two figures has allowed the person who made that figure to come up with 157. The figure itself is erroneous, and it is important that it is not repeated until there is a proper statistical base that can be shared with local people, because it will clearly frighten people. It is important that that figure, if it is true at all, has a proper statistical base before it is used.

Likewise, figures have been quoted about PFI. I actually have a dogmatic view on PFI, which is that it is a less than elegant way of borrowing money. Classically, the Government will borrow money at around 4%, and the private sector at 6% or 7%. One can get PFI deals that work; there are some. They work when one can incentivise efficiency over a long period, but it is very difficult to measure, and the jury is still out on even the best deals. There are circumstances in which they do work, but they do not work in every circumstance.

None the less, it is important that we present local people with the figures. My hon. Friend the Member for Colne Valley has mentioned in the House the figure of £773 million over the course of the contract; I believe that that figure is just the sum of all the unitary payments made year by year. If we strip out inflation, as we must in order to come to a real figure, we arrive at a sum that is about two thirds of that: £527 million. If we then subtract from that £527 million the costs of providing maintenance, cleaning, porterage and the other functions that form part of the PFI deal, we come to a figure about half that, or about £263 million or £264 million. It is difficult to divide it up precisely, because it is a unitary payment. That is the financing charge.

If we compare that financing charge with what it would have been for public debt if the money had been borrowed, as it would have been at the time in order to build the hospital, we are talking about a difference of about £90 million to £100 million. Again, when presenting these figures to the public, it is very important that we are consistent about it. This figure is not £773 million and in that sense it does not matter who signed it, and I will be the first person to stand here for hours defending Sir John Major. It is much closer to £100 million over and above what would have been paid for had it been public debt.

Again, I think that puts it in context and may explain why this figure is not the defining figure, because when £100 million is divided up by the course of the contract it comes out at a much smaller figure than might be supposed. It is not the determining factor in what the CCG is trying to do, and I am convinced of the CCG’s arguments in that respect.

However, the CCG is very open about the value for money that it says there is in using the Halifax site as opposed to the Calderdale site, and Members should discuss that with the CCG. They might have a very interesting discussion with it about how it will dispose of the capital one way or another.

I will just run through the CCG’s proposals quickly in response to the problems it has identified in the local area, and then I will just turn quickly to some of the additional comments that have been made by Members.

The trust identifies that in the area the summary hospital-level mortality indicator—the SHMI mortality figure—was 108.9 in March 2015 against an expected benchmark of 100, so it is significantly over the expected figure. The trust did not achieve a reduction in its mortality rate during 2014 and 2015; it was not able to narrow the gap in the mortality rate to 100. In large part, it puts that down to the operating problems it has on the two sites.

Therefore, the trust’s answer to that problem is to provide exactly the kind of specialised concentrated care that Members from all parties have identified—albeit they think it is in the wrong place—as part of a joined-up community care plan, which it is developing in co-ordination with the wider local area.

The hon. Members for Dewsbury and for Batley and Spen came to speak to me in great detail, and very interestingly, about the proposals for their area. I take very seriously the remarks that the hon. Member for Batley and Spen made about looking at the wider area of mid-Yorkshire in co-ordination with this work.

I do not know whether I have been to Huddersfield and I told the hon. Member for Huddersfield why. I spent the first year of my life in Wakefield, as I explained to the hon. Members for Dewsbury and for Batley and Spen the other day, and so maybe my mother took me to Huddersfield. I would like to return in the near future and experience it properly as an adult, and I shall. Nevertheless, it is clear that the area we are discussing is a very complicated one to deal with. It is a hilly area, something which—being a boy from East Anglia—I do not understand very well, and it has a lot of towns of considerable population that are divided by difficult terrain, and travelling between those towns can be less simple than travelling in other parts of the country. So I take on board the points that the hon. Gentleman made.

I will certainly take back the suggestion by the hon. Member for Batley and Spen that this issue we are debating today should be looked at in the wider context, and I undertake to ask Jim Mackey to see whether there is a co-ordination between these two plans and whether he can encourage the CCGs to adopt a more joined-up approach to what they are doing. Maybe they are already joined up—I am not prejudging the conversations that have happened—but it is important that the CCGs answer these questions.

[Mr Sheerman]

On the figures, we listened intently on the lesson on PFI. But these figures have been in the public domain from many sources since the announcement and the PFI has been looked at. People find these sums difficult to understand. It is our job to ensure that we make the toughest case we can. Yes, we have used those figures, and they are still pretty appalling. Regarding the figure of 157, we got it from an impeccable source; we will go back and check it, but I think it is good.

[Ben Gummer]

I would submit both figures. There is a difference between £773 million and £100 million, although one is larger than the other. I am not justifying the original deal, but it is important that we put it in context.

My hon. Friend the Member for Colne Valley asked me whether I would arrange a meeting with the Secretary of State; of course, I will be happy to do so. However, can we wait for some of these issues to have been thrashed out with the CCG, so that we have a proper evidence base that we all agree on? That is part of the point of a consultation. Then we will have an even better informed meeting than if we had one tomorrow. So let us have a proper public debate locally and allow the CCG to respond to some of the accusations that have been made here and elsewhere.

My hon. Friend also asked about investigations into the PFI deals. Each PFI deal is different; some are legally very difficult to unpick while some are easier. We have unpicked quite a few during the past few years and I know that the team are looking at all the PFI deals on a revolving basis. Therefore, I can make a commitment that the Department of Health will continue to look at PFI deals—each and every one of them—to see whether we can get more value from them. However, I have to be clear with my hon. Friend that this deal, which was one of the earliest to be made, has been very carefully worded.

[Jason McCartney]

This gets to the nub of the matter. May I just confirm that the Minister’s team will specifically look at the Calderdale PFI, because it was a bit generic there as well? There are discrepancies over the figures, which are slightly different. Incidentally, my colleagues and I would be absolutely delighted if this process were not being influenced by the PFI; if the issue is down to clinical reasoning and other matters, Huddersfield will keep its A&E unit.

[Ben Gummer]

I can guarantee that Lord Prior is looking at every single PFI in the country on a revolving basis, because we are trying to ensure that we can squeeze maximum—

[Jason McCartney]

But this one.

[Ben Gummer]

This one is part of “every single PFI in the country”, so I assure my hon. Friend that it will be looked at.

[Mr Sheerman]

Perhaps it would be helpful to the Minister if—

[Ben Gummer]

May I just respond to my hon. Friend’s original point?

We must remember that the PFI deal is borne by the entire trust, so it is not as if it fixes precisely on one site or another; it does not influence the decision of where to go. It could be possible to run a cold site on the PFI hospital and fill the hospital that way. It does not have to be filled with the particular function that the CCG wishes to put there. The CCG just believes that the buildings there are better, more suited and more modern—the hon. Member for Huddersfield would agree with that assessment—for the particular purposes it wants to put there.

It is for the CCG to justify that; I cannot speak with any authority about this, because I do not know. However, I really do not think that the PFI has a bearing, because no matter where the services are put, the PFI deal will still exist. All I am saying is that I want to be realistic about our ability to unpick every single PFI in the country, because in many cases they have been very carefully worded and agreed in a lawyerly fashion—

[Mark Pritchard (in the Chair)]

Order. I remind colleagues and the Minister, first, that the Minister should face inwards, so that we can get a good shot of him on camera. This debate is being televised—just a gentle reminder. Secondly, those Members who want to make comments should stand up to do so, so that the Hansard writers can identify who they are. Thank you very much indeed.

[Mr Sheerman]

Thank you, Mr Pritchard. I hope this is a useful intervention. We have written to the Public Accounts Committee to ask it to have a look at this particular PFI, on the basis that it would be a very good one to try to unpick. That might be helpful to the Minister and us.

[Ben Gummer]

I am sure that the Chairman of the PAC will listen carefully to the hon. Gentleman, who is her esteemed colleague. I know that the PAC has looked at the PFI issues many times before, but I would be glad if it were willing to look at them again.

The hon. Member for Dewsbury raised the issue of traffic, as did other hon. Members. Again, it is for the CCG to ensure that it justifies the traffic times that it is putting in the consultation document. I have sympathy with Members who say that these consultation documents are often impenetrable. I cannot speak for this one, because I have not read it in its entirety, but such documents must be written well—especially the parts that will be put to local people—so that they are understandable to people who do not speak NHS-speak. It is not a question of people’s intelligence; it is about ensuring that the document is written in normal English in a way that people can understand. As to whether the document could ask, “Would you like your A&E to move?”, as long as people are informed about the facts of the case and understand that such a move could improve their children’s outcomes, and there is a reasonable case for it, I see no reason why that question should not be put.

The hon. Member for Huddersfield and the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), both raised the issue of wider deficits across the NHS. We addressed that point in the urgent question yesterday; there is financial pressure in the NHS and there are reasons why that should be the case, which I will not go into now. The issue is not cuts, because the amount of money going into the NHS is increasing. The NHS faces a raft of challenges, as it has since its foundation, and our job is to ensure that the money is used as efficiently as possible, which is why we have brought in the controls on consultancy spend, locums and agency workers.

What is true is that under the previous Labour Government and the coalition Government, the number of doctors in training went up. I genuinely do not blame the previous Labour Administration for the current shortages, but we have inherited the numbers from decisions made in the 2000s about the length of doctor training, and before that date about consultant grades. The fact is that, in some parts of the country, it is difficult to recruit—sometimes because the clinical base under which consultants, especially A&E consultants, are asked to operate is not safe. Again, I cannot speak, publicly, about the situation in either of the two hospitals under debate, but that is the case elsewhere, while in some metropolitan centres it is easy to recruit vast numbers of doctors. How do we create hospital bases to which we can recruit clinicians who want to work in a safe place, and carry out good procedures—and numerous ones, to keep the rates up? That is one of the challenges for all healthcare systems across the world, and one that we are determined to meet here in England.

Finally, the shadow Minister spoke about the overall control of finances in the NHS. It is important not to link the overall financial performance of the NHS with this consultation, which, as the CCG makes clear, is centrally about clinical outcomes. I know that the shadow Minister cares very much about ensuring good clinical outcomes, as do all hon. Members; to do that, it is important that local people get a full grasp of the facts. Although we might have a broader argument about NHS finances, it is important to focus on the core facts of the situation. This is about clinical outcomes, the difficulty of providing the outcomes on two sites where they are best provided on a single co-located site, and the value-for-money arguments about what that site should be.

If we can have a strong, well-informed and nuanced debate, and take into consideration the surrounding area—a point well made today—local people can come to a good decision that is supported across the patch, which will mean better health services for those living in Huddersfield and Halifax and the surrounding areas, an improvement in clinical outcomes, and better life chances, especially for those who are born with the least.

[Mr Sheerman]

I used to have good discussions with the Minister’s father. One thing I know about him is that he, like me, was really interested in good management. The Minister has not come back to us about the quality of management, which is something that CCGs in many places do not seem to have. Good managers in the health service seem to be undervalued. I made what I think was a good point about medical training not containing any management element. I am sorry to remind the Minister of his father’s excellent commitment to good management, but I am sure that he shares that view.

[Ben Gummer]

I share the view of the hon. Gentleman. Good management is, of course, vital in the NHS, which is why I am never particularly keen to beat up NHS managers—a predilection of politicians on both sides. But it is true that we have not considered carefully enough the quality of management in CCGs; I agree with the hon. Gentleman about that. That is precisely why we are bringing in a CCG scorecard, just as we have done with the Care Quality Commission rankings for hospitals—that is a well-led domain—that describes precisely how well a hospital is managed.

We want to do similar work for CCGs, which will enable the hon. Gentleman to say, “Empirically, my CCG is poorly—or well—managed compared with neighbouring ones”. That will be useful for our holding them to account. I agree with the hon. Gentleman, and I hope that I will be able to deliver, in the next year, precisely what he wants.